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Step 2 Flashcards

1
Q

Treatment for Akathisia

A

Beta Blocker- Propranolol (1st line);

Benzodiazeopine - Lorazepam (2nd line)

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2
Q

Treatment for Acute Dystonia

A

Diphenhydramine or Benztropine

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3
Q

Treatment for Drug Induced Parkinsonism

A

Benztropine or Amantadine

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4
Q

Treatment of Intrahepatic Cholestasis of Pregnancy

A

Ursodeoxycholic Acid (UDCA)

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5
Q

Cause of Acute Bacterial Parotitis

A

Staph Aureus infection typically in post-operatively dehydrated patients (can be prevented by adequate hydration and oral hygiene)

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6
Q

Silent Thyroiditis

A

Mild brief hyperthyroid phase, small non-tender goiter, positive TPO antibody, Low radioactive uptake (UNLIKE GRAVES)

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7
Q

Subacute Thyroiditis (de Quervain)

A

Often post-viral, painful tender goiter with hyperthyroid symptoms, elevated ESR

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8
Q

Graves Disease

A

Hyperthyroidism due to increased synthesis of thyroid hormone, radio-iodine uptake is diffusely increased

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9
Q

Effect of Estrogen on Thyroid

A

Increased TBG concentration with estrogen/in pregnancy; If hypothyroid, will need to increase levothyroxine dose
Increase in total thyroid level (minimal increase in free)

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10
Q

Most Common Thyroid Cancer

A

Papillary (70-90%, psamomma bodies, ground glass), followed by Follicular (Hurthle cells can be seen in both)

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11
Q

Requirements of Brain Death

A

Coma, no brain or brainstem function (no gag reflex, pupil light reflex, corneal reflex, cough, posturing, caloric response), positive apnea test

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12
Q

Drugs that Prevent Cardiac Remodeling/Decrease Mortality

A

ACE inhibitors, ARBs, B-blockers, Spironolactone

Hydralazine + Nitrates (in African Americans)

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13
Q

Antibiotics for MRSA

A

Clindamycin, Trimethoprim-sulfamethoxazole, or Vancomycin

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14
Q

Treatments for Mastitis

A

Dicloxacillin or Cephalexin

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15
Q

Disorders Affecting Anterior Horn Cells

A

Spinal Muscular Atrophy, ALS, Poliomyelitis

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16
Q

Guillain Barre Has Effects On

A

Peripheral Nerves, demyelination of motor nerves (acute ascending polyneuropathy)

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17
Q

Treatment of Guillain Barre

A

Immunoglobulin or plasmapheresis

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18
Q

Treatments of Acute Abnormal Uterine Bleedings

A

High dose IV or oral Estrogen, High dose combined OCP, High dose progestin pills, Tranexamic acid

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19
Q

Sonohysterogram Used To Evaluate

A

Uterine cavity for fibroids or polyps

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20
Q

Opioid Withdrawal Symptoms

A

Mydriasis (dilated pupils), N/V, diarrhea, diaphoresis, abdominal pain, rhinorrhea, lacrimation, hypertension

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21
Q

Indications for NSTs

A

High risk pregnancy starting at 32-34 weeks (2x/week)

Perceived decrease in fetal movement

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22
Q

NST

A

Reactive/Normal is at least 2 accelerations (15 for 15sec) in FHR within 20 minutes

  • May be non-reactive during fetal sleep cycle
  • Vibroacoustic stimulation used to awaken fetus
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23
Q

Typical Causes of Hyperventilation

A

Pneumonia, High Altitude, Salicylate Poisoning, Pulmonary Embolism

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24
Q

Causes of Metabolic Acidosis (Anion Gap)

A

MUDPILES (anion gap): Methanol, uremia, DKA, propylene glycol, INH, lactic acidosis, ethylene glycol, salicylates

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25
Q

Causes of Metabolic Acidosis (Non-Anion Gap)

A

Diarrhea and Renal Tubular Acidosis

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26
Q

Causes of Metabolic Alkalosis

A

Vomiting, Loop Diuretics, Hyperaldosteronism

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27
Q

Anticonvulsants for Absence Seizures

A

Ethosuximide or Valproic Acid

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28
Q

Causes for Liver Enzymes in the 1000s

A

Viral Hepatitis, Medications (e.g. acetaminophen), Autoimmune, Shock/Ischemic Liver

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29
Q

Indications to Screen for HIV

A

Age 15-65, risk factors (IVDA, MSM, HIV+ partner), pregnancy, occupational exposure, hx of another STD, etc.

  • Preferred testing: HIV p24 antigen and HIV Antibodies
  • Positive test is confirmed with HIV-1/HIV-2 Antibody Immunoassay
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30
Q

Treatment for Symptomatic HOCM

A

Negative inotropic agents: beta blockers (MC initial therapy, metoprolol or atenolol), verapamil, or disopyramide
- Avoid vasodilators that will decrease preload

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31
Q

Indications for Carotid Endarterectomy

A

Asymptomatic: if >60% in men or >70% in women
Symptomatic: if >50% in men or >70% in women

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32
Q

Friedreich Ataxia

A

MC type of spinocerebellar ataxia

  • Frequent falls, ataxia
  • Scoliosis and hammer toes
  • Hypertrophic Cardiomyopathy
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33
Q

Pernicious Anemia

A

Signs and symptoms of B12 deficiency: macrocytic anemia, glossitis, and peripheral neuropathy

  • Risk of chronic atrophic gastritis and risk of gastric cancer
  • Anti-intrinsic factor antibodies decreases B12 absorption
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34
Q

CD4 count

A

Pneumocystis jirovecci: trimethoprim-sulfamethoxazole

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35
Q

CD4 count

A

Toxoplasma: trimethoprim-sulfamethoxazole

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36
Q

CD4 count

A

MAC (mycobacterium avium): Azithromycin

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37
Q

CD4 count

A

Histoplasma: Itraconazole

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38
Q

Best diagnostic tool for Acute Diverticulitis

A

Abdominal CT with contrast

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39
Q

Anticoagulation for DVT

A

Start on unfractionated Heparin, followed by Warfarin 6 hours later
- Do not start warfarin alone, transient hypercoaguable state

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40
Q

Refeeding Syndrome

A

Insulin secretion causes cellular uptake of Phosphorus, Potassium, and Magnesium
- Risk of arrhythmias and cardiopulmonary failure

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41
Q

Pregnant Mothers with Active Hep B

A

Infant should receive both Hep B vaccine and HBIG

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42
Q

Dopamine Pathway: Mesolimbic

A

Antipsychotic efficacy

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43
Q

Dopamine Pathway: Nigrostriatal

A

EPS: Acute dystonia, akathisia, parkinsonism

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44
Q

Dopamine Pathway: Tuberoinfundibular

A

Hyperprolactinemia: amenorrhea, galactorrhea, gynecomastia, and sexual dysfunction

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45
Q

Pertussis Treatment

A

Macrolides (azithro, clarithro, erythro)

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46
Q

Pertussis vs Croup

A

Pertussis: bordetella, whooping cough 3 stages (catarrhal, paroxysmal, convalescent)
Croup: Parainfluenza, barky cough, inspiratory stridor, steeple sign

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47
Q

Acute and Chronic Psych Symptoms with SLE

A

Psychosis, depression, mania, and anxiety

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48
Q

Biliary Colic vs Acute Cholecystitis

A

Biliary Colic due to gallstones: recurrent symptoms that resolve within 4-6 hours, no tenderness, fever or leukocytosis
Acute Cholecystitis: >6 hrs, fever, leukocytosis, Murphys sign

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49
Q

Posterior Urethral Injury

A

Aw/ Pelvic fractures

Blood at urethral meatus, high riding prostate, and scrotal hematoma

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50
Q

GERD Symptoms

A

Sore throat, morning hoarseness, cough worse at night, chest pain/heartburn, dysphagia, regurgitation

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51
Q

Upper Airway Cough Syndrome

A

Post nasal drip, dripping in throat feeling, chronic cough without rhinorrhea
- Tx: diphenhydramine

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52
Q

Aspirin Exacerbated Respiratory Disease (AERD)

A

In patients with asthma and chronic rhinosinusitis

  • symptoms of nasal congestion after ingestion of NSAIDs
  • worsening of asthma
  • nasal polyps
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53
Q

Time Criteria to meed Generalized Anxiety Disorder

A

Symptoms lasting >6 months. Anxiety about multiple issues

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54
Q

Germinal Matrix Bleed

A

Occurs in premature or low birth weight infants

- Bulging fontanel, focal neurologic signs, seizures, pallor

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55
Q

Fetal Hydantoin Syndrome

A

Aw/ anticonvulsant medications, phenytoin and carbamazepine

- midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, developmental delate

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56
Q

SIADH

A

Euvolemic Hyponatremia
Urine osmolarity > serum osmolarity
Urine Na > 20
Serum osmolarity

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57
Q

Psychogenic Polydipsia

A

Euvolemic Hyponatremia

Decreased urine osmolality

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58
Q

Hypovolemic Hyponatremia

A

Diuretic overuse, interstitial nephritis, or salt-wasting conditions
- BUN and Cr would be elevated

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59
Q

Side effects of Cyclosporine

A

Nephrotoxicity, HTN, Neurotoxicity, Glucose intolerance, Gingival hyperplasia, GI manifestations, Hirsutism, Malignancy

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60
Q

Side effects of Tacrolimus

A

Neurotoxicity, diarrhea, and glucose intolerance

- higher incidence than with cyclsporine

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61
Q

Side effects of Azathiprine

A

Dose related diarrhea, leukopenia, and Hepatotoxicity

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62
Q

Side effects of Mycophenolate Mofetil

A

Bone marrow suppression

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63
Q

First Degree Heart Block

A

Prolonged PR interval

- Observe

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64
Q

Leukemoid Reaction vs Chronic Myeloid Leukemia (CML)

A

LR: severe infection and marked leukocyte counts (>50,000), Late neutrophil precursors, High LAP (alk phos)
CML: Low LAP, early neutrophil precursors, absolute basophilia

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65
Q

Positive Predictive Value

A

How likely a positive test is to be true, want more true positives than false positives
- Decreasing the cutoff value, decreases the PPV because more false positives

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66
Q

Renal Transplant Dysfunction

A

In the early post-op period:

  • Ureteral obstruction
  • Acute rejection (Lymphocyte infiltration, tx with IV steroids)
  • Cyclosporine toxicity
  • Vascular obstruction
  • ATN
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67
Q

Cyanide Toxicity

A

If ingested: activated charcoal
Antidote: hydroxycobalamin (1st) or sodium thiosulfate, if unavailable then nitrites
Housefire/smoke exposure: hydrogen cyanide and CO
Cyanide: binds cytochrome A3 in ETC chain, blocking oxidative phosphorylation –> lactic acidosis

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68
Q

Diabetic Medications: Weight loss

A

Metformin (1st line), GLP-1 agonist (exenatide, liraglutide)

- everything else causes weight gain

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69
Q

Side effects of Thiazolidinediones

A

Eg. Pioglitizone
Can potentially induce CHF in patient with heart dz
Risk of bladder cancer
Weight gain

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70
Q

Diabetes Medications: Hypoglycemia

A

Sulfonylurea, Insulin

Low risk with TZDs and DPP4 inhibitors (gliptins)

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71
Q

Ventilator Associated Pneumonia

A

Empiric Abx to cover for Gm + and -, pseudomonas, and MRSA

  • nosocomial PNA develops at least 48 hours after intubation
  • MC: pseudomonas, e.coli, klebsiella, MRSA, strep
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72
Q

Location of Ulcers from Venous Insufficiency

A

Medial aspect of leg, above medial malleolus

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73
Q

Location of Ulcers from Neuropathy

A

Pressure/weight bearing points of feet, soles of feet, below head of first metatarsal

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74
Q

Location of Ulcers from Arterial Insufficiency

A

Tips of digits (fingers or toes)

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75
Q

Primary Adrenal Insufficiency

A

Hypotension, hyperpigmentation (Elevated ACTH, Low cortisol)
Hyponatremia, Hyperkalemia (Low Aldosterone)
Eosinophilia
MC cause in developed countries: Autoimmune (80%)
Hemorrhage (warfarin, meningococcemia, pseudomonas) less likely

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76
Q

Rheumatic Heart Disease: Atrial Fibrillation

A

Mitral stenosis –> dilation of left atrium –> atrial fibrillation –> loss of atrial kick and worse flow –> increased lung congestion –> dyspnea

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77
Q

Prevention of Pneumococcal Sepsis in Sickle Cell Anemia

A

PPSV23 vaccination (protection against encapsulated organism) and twice daily penicillin (till age 5)

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78
Q

Galactose 1 phosphate uridyl transferase Deficiency

A

Galactosemia
Vomiting, failure to thrive, bilateral cataracts, jaundice, and hypoglycemia, can lead to mental retardation if untreated
- Increased risk of E. Coli sepsis

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79
Q

Galactokinase Deficiency

A

Cataracts, otherwise asymptomatic

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80
Q

Gonococcal Conjunctivitis

A

2-5 days after birth
Copious exudates and eyelid swelling
Tx: IV ceftriaxone or cefotaxime
Ppx: erythromycin ophthalmic ointment (will not prevent chlamydia)

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81
Q

Chlamydial Conjunctivitis

A

5-14 days after birth
Presents with chemosis, moderate eye swelling
Watery, mucoid discharge (less purulent)
Tx: Oral erythromycin

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82
Q

Infective Endocarditis (Duke Criteria)

A

Major Criteria: +blood cultures, echo showing vegetations
Minor Criteria: IVDA, prior cardiac malformation, fever, embolic phenomenon (splinter hemorrhages, osler nodes, janeway lesions, roth spots, petechia), glomerulonephritis, heart murmur
2 major OR 1 major + 3 minor

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83
Q

Cerebellar Lesion

A

Ipsilateral Ataxia, nystagmus, intention tremor, loss of coordination, dysmetria
- Fall toward side of lesion

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84
Q

Leriche Syndrome

A

Aortoiliac occlusion: triad of bilateral hip, thigh, and buttock claudication, impotence, and symmetric atrophy of bilateral lower extremities

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85
Q

Contraindications to Trial of Labor

A

Classical (vertical) incision and Hx of abdominal myomectomy with uterine cavity entry

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86
Q

Epithelial Ovarian Carcinoma

A

SOB, constipation, vomiting, abdominal bloating, early satiety, abdominal pain, increased CA125
- U/S: solid components, thick septations, ascites

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87
Q

Endometriomas

A

Homogenous cysts with internal echoes (ground glass)
Common cause of pelvic pain in premenopausal women
Endometrial glandular tissue on ovary

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88
Q

Mature Teratoma Adnexal Mass

A

Hyperechoic nodules and calcifications, may have solid components

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89
Q

Cushings Reflex

A

HTN, bradycardia, respiratory depression

Due to increased ICP (possibly impending herniation, may see oculomotor nerve dysfunction)

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90
Q

Uncal Herniation (transtentorial)

A

Ipsi hemiparesis
Ipsi oculomotor paralysis (eye down and out)
Contra homonymous hemianopsia

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91
Q

Opening Snap w/ Low Pitched Diastolic Rumble

A

Mitral Stenosis

- likely due to RHD

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92
Q

Multifocal Atrial Tachycardia

A

Frequent atrial premature beats often aw/ severe lung dysfunction (e.g. interstitial lung disease)

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93
Q

Varicella Post-Exposure Prophylaxis

A

If immunized: observation
If non-immune: Varicella vaccine
If non-immune & immunocompromised: VZIG

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94
Q

Evaluation of Bilious Vomiting

A

NG decompression and IV fluids
Abdominal X ray (first)
If dilated bowel: contrast enema (Meconium ileus or Hirschsprung)
If free air/unstable: surgery (Perforation)
If gas-less abdomen: upper GI series (contrast) (Malrotation)
If double-bubble: duodenal atresia

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95
Q

Reye’s Syndrome

A

Hepatoencephalopathy due to aspirin in children with viral infections

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96
Q

Treatment of Tourette’s

A

2nd Gen Antipsychotics (Risperidone)

Pimozide (not first line)

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97
Q

Polymyositis vs Polymyalgia Rheumatica

A

Polymyositis: proximal muscle weakness, elevated liver/muscle enzymes, abnormal electromyography, aw/ malignancy
Polymyalgia: aching and stiffness in shoulders, hips, torso, but no muscle tenderness, elevated ESR, resolves with low dose steroids, >50 yrs

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98
Q

Treatment for Acute Mania

A

Antipsychotics, lithium, and anticonvulsant mood stabilizers (valproate, carbemazepine)
- 1st or 2nd Gen antipsychotics to manage mania and acute behavioral agitation (other medications take several days before having effect)

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99
Q

Envelope shaped Kidney Stones

A

Calcium Oxalate (MC type, 75-90%) & Calcium Phosphate
Risks: Hypercalciuria, ethylene glycol, vit C abuse, Crohns (unabsorbed fatty acids bind calcium, so more oxalate free to be reabsorbed)
Tx: citrate or thiazides, reduce sodium in diet

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100
Q

Coffin Lid Kidney Stones

A

Struvite (Ammonium Mag Phosphate)
UTI from Proteus, Staph, Klebsiella
Alkaline urine

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101
Q

Uric Acid Kidney Stones

A

Radiolucent (not seen on Xray)
Aw/ gout or leukemia
Tx: Alkalinize urine (potassium citrate)

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102
Q

Hexagonal Kidney Stones

A

Cystine (secondary to cystinuria)
+Sodium Nitroprusside Test
Can form Staghorn
Tx: Alkalinize urine

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103
Q

CMV Colitis

A

Blood diarrhea in patients with CD4 counts

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104
Q

CAH: 21 Hydroxylase Deficiency

A

Build up of 17 Hydroxyprogesterone
Salt wasting hypotension
Ambiguous genitalia in girls

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105
Q

Spherocytes with +Coombs

A

Autoimmune Hemolytic Anemia (AIHA)

Due to autoantibodies to RBCs

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106
Q

Erysipelas

A

Cellulitis caused by Group A Strep (S. Pyogenes)

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107
Q

Innocent Murmurs

A

Decreased intensity with standing and valsalva
Systolic
Grade I-II
Low pitches, musical, pure, or squeaky at LLSB
High pitched at LUSB
Asymptomatic, negative family Hx

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108
Q

Benzodiazepines in Elderly

A

Risk of falls, confusion, and paradoxical agitation (typically within 1 hour)

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109
Q

Hyperkalemia: cardiac stabilization

A

Calcium gluconate infusion

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110
Q

Hyperkalemia: rapid treatment to decrease serum K

A

Insulin + Glucose
Beta 2 agonists
Sodium Bicarb
(Diuretics, kayexelate, and Dialysis are slow acting)

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111
Q

Rare Disease Assumption

A

OR is a close approximation of RR incase-control studies where the outcome is uncommon

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112
Q

Obstructive Sleep Apnea: Acid Base

A

Hypoventilation causes chronic hypoxia and hypercapnia

- Compensate by metabolic alkalosis (bicarb retention)

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113
Q

Congenital Heart Defect: Hypoxia failing to improve with supplemental O2

A

Give Prostaglandin E1 to keep a Patent Ductus Arteriosus

- Closure in a PDA dependent defect can shock & acidosis

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114
Q

Arrest of Labor

A

Dilation of at least 6cm w/ ruptured membranes and 1 of the following:
No cervical change for at least 4 hrs despite adequate ctx
No cervical change for at least 6 hrs w/ inadequate ctx

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115
Q

Adequate Contractions

A

Sum up to at least 200 montevideo units over 2 hours

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116
Q

Shoulder Dislocation Due to Seizure

A

Posterior dislocation

- Shoulder is adducted and internally rotated

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117
Q

Vaginal Cancer

A

MC is Squamous Cell; over age 60
Risks: HPV and smoking, Hx of cervical dysplasia
- Upper 1/3 of the posterior vaginal wall
- Malodorous vaginal discharge, bleeding, mass on vagina

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118
Q

Vaginismus

A

Involuntary contraction of perineal musculature
-Psychological cause
Tx: relaxation, Kegel exercises to relax vaginal muscles, and insertion of dilators

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119
Q

Treatment for a Human Bite

A

Ppx with Amoxicillin-clavulanate

- Also used for dog bites and cat bites

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120
Q

MEN1

A

Parathyroid
Pituitary
Pancreatic

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121
Q

MEN2A

A

Parathyroid
Medullary Thyroid
Pheochromocytoma

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122
Q

MEN2B

A

Mucosal Neuroma/Marfanoid habitus
Medullary Thyroid
Pheochromocytoma

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123
Q

Isolated Systolic Hypertension

A

HTN in elderly due to decreased elasticity of arterial wall

  • Wide pulse pressure
  • Tx: low dose thiazide, ACEi, or long acting CCB
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124
Q

Drugs to Avoid in WPW

A

Adenosine, Beta Blockers, CCBs, and Digoxin
(can increase conduction through accessory pathway)
- Can use Procainamide or Quinidine, if unstable then cardioversion

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125
Q

Treatment for PSVT (Paroxysmal SVT)

A

Vagal Stimulation: carotid sinus massage, valsalva, cold water immersion
IV Adenosine

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126
Q

Treatment for VTach (wide complex tachycardia)

A

If unstable: DC cardioversion

If stable: IV amiodarone preferred

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127
Q

Blunt Abdominal Trauma Evaluation

A

After appropriate fluid resuscitation
FAST scan to assess for intraperitoneal free fluid or hemorrhage
If limited or equivocal, can do DPL (diagnostic peritoneal lavage)
If either FAST or DPL is positive, ex laparotomy

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128
Q

Nonseminomatous Germ Cell Tumor

A

AFP and B-hCG

In anterior mediastinum (usually primary)

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129
Q

Seminoma

A

B-hCG (does not produce AFP)

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130
Q

Rotor Syndrome

A

Defect in hepatic secretion of conjugated bilirubin

Positive urine bilirubin (has to be conjugated to be in urine)

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131
Q

Drugs Aw/ Photosensitivity

A

Doxycyline (tetracyclines), Chlorpromazine, Prochlorperazine, Furosemide, HCTZ, Amiodarone, Promethazine

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132
Q

Treatment for Urge Incontinence

A

Detrusor overactivity treated with Antimuscarinics
- Oxybutynin
If Pelvic floor exercises and bladder training fail

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133
Q

Lipid Lowering Guidelines

A

Atherosclerotic Dz + under age 75: High intensity statin
Atherosclerotic Dz + over age 75: Mod intensity statin
Age 40-75 w/ DM with ASCVD risk >7.5%: High intensity
Age 40-75 w/ DM with ASCVD risk 7.5%: Mod to High intensity statin

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134
Q

Essential Tremor

A

Action tremor of hands, no other neurological signs

  • relieved with EtOH
  • Tx: propranolol, primidone, or topiramate
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135
Q

Parkinson’s Tremor

A

Resting tremor, decreases with voluntary movement

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136
Q

Cerebellar Tremor

A

Aw/ ataxia, dysmetria, or gait disorder

Increases as hand reaches target

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137
Q

Treatment for Cryptococcal Meningitis

A

Amphotericin B with Flucytosine intitially

- Maintenance with Fluconazole

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138
Q

Vertebral Osteomyelitis MC Occurs in:

A

Sickle cell, IVDA, and immunosuppressed patients

- Tenderness to gentle percussion, ESR elevated

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139
Q

MI Complications: Acute (within 24 hrs)

A

CHF, Cardiogenic Shock, RV failure, Arrythmia, Death

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140
Q

MI Complications: 3-5 days

A

Papillary muscle rupture (acute Mitral Regurg)

Interventricular septum rupture

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141
Q

MI Complications: 5-14 days

A

Free wall rupture

LV Pseudoaneurysm

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142
Q

MI Complications: weeks to months

A

Dressler’s Syndrome (immune pericarditis)

True ventricular aneurysm

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143
Q

MI Complications: 1-3 days

A

Acute Pericarditis

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144
Q

Graft vs Host Disease

A

Donor T cells attack the host

  • Rash
  • GI symptoms
  • Abnormal liver tests
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145
Q

McCune Albright Syndrome

A

Precocious puberty
Cafe au lait spots
Multiple bone defects (Polyostotic FIbrous dysplasia)

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146
Q

Rh(-) Anti -D Immune Globulin

A 
Standard dose of 300ug at 28 weeks to prevent alloimmunization
May need higher dose after delivery, procedures, or abruption
Kleihauer Betke (KB) test used to determine dose
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147
Q

Ethylene Glycol vs Methanol Ingestion

A 
Metabolic Acidosis with anion gap
Ethylene:  (Tx with Fomepizole)
- Envelope shaped Calcium-oxalate crystals
- Acute renal failure, flank pain
Methanol 
- Can cause blindness
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148
Q

Electrical Alternans

A

Seen with Cardiac Tamponade

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149
Q

Pulsus Paradoxus

A

Seen with Cardiac Tamponade

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150
Q

Pulsus Parvus et Tardus

A

Seen with Aortic Stenosis

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151
Q

Marjolin Ulcer

A

Squamous cell carcinoma that forms in area of a burn wound that undergoes extensive chronic healing/scar formation

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152
Q

Fluphenazine Side Effect

A

Can cause hypothermia due to inhibition of body’s shivering mechanism and/or inhibiting autonomic thermoregulation

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153
Q

Digoxin Toxicity

A 
N/V, vision changes (blurry, blue-green color)
Fatal arrhythmias (Atrial Tachycardia with AV block)
Worsened with Hypokalemia
Worse with Amiodarone (need to lower Digoxin dose)
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154
Q

CML

A

BCR-ABL (Chr 9:22 translocations)
Leukocytosis, absolute basophilia, early neutrophil precursors (promyelocytes, myelocytes)
Tyrosine kinase constitutively active
Tx: Imatinib

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155
Q

Malignant Otitis Externa (MOE)

A

Severe ear pain, purulent drainage, conductive hearing loss, edematous external canal with granulation tissue
- may have facial droop if nerve damage
Pseudomonas Aeruginosa
MC in elderly, poorly controlled diabetics, and immunosuppressed
Tx: IV Ciprofloxacin, or Piperacillin, or Ceftazadime

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156
Q

Indication for Cystoscopy

A

Unexplained gross hematuria or with microscopic hematuria and other risk factors for bladder cancer (smoking, exposures, chronic cystitis, cyclphosphamide, radiation)

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157
Q

Treatment for TCA overdose

A

Sodium Bicarbonate
- Prevents cardiac problems (QRS widening or ventricular arrhythmias)
Activated charcoal if

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158
Q

Anterior Spinal Cord Syndrome

A

Loss of motor function, pain and temperature below level of injury
- position/vibration/touch intact
Due to spinal cord infarction
Can be a complication of thoracic aortic aneurysm repair (reduced blood flow causing infarction)
Ant 2/3 of cord

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159
Q

Scaphoid Fracture Management

A

If initial Xray is negative, immobilize and xray again in 7-10 days
If xray shows nondisplaced fracture, immobilize for 6-12 weeks
If displaced/angulated fracture, surgical reduction needed

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160
Q

Length of Treatment with Antidepressant

A

Single episode: continue for 4-9 months after improvement

Recurrent/chronic: 1-3 years or indefinitely

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161
Q

Premature Ovarian Failure

A 
Hypergonadotropic Hypogonadism
Menopause before age 40
Elevated FSH (low estradiol)
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162
Q

Amenorrhea Due to Hyperprolactinemia

A

Inhibits GnRH release

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163
Q

Gestational Diabetes

A

Macrosomia, neonatal hypoglycemia, organomegaly, heart defects, polycythemia

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164
Q

Treatment of a Breast Abscess

A

Needle aspiration and antibiotics (dicloxacillin, cephalexin)
Continued breast feeding
I and D if not responding to aspiration + abx, suspected necrosis, or >5cm pus collection

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165
Q

Bronchiolitis

A

Age

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166
Q

Beckwith Wiedemann Syndrome

A

Fetal macrosomia, umbilical hernia, macroglossia, hemihyperplasia
Monitor for Hypoglycemia
Risk of Wilms Tumor and hepatoblastoma
- Abd U/S and AFP levels regularly

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167
Q

Henoch Schonlein Purpura (HSP)

A

Abdominal pain, lower extremity purpura, arthritis

IgA nephropathy

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168
Q

Acid Base of Chronic COPD

A

Respiratory Acidosis with compensatory Metabolic Alkalosis (kidney retention of bicarb)

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169
Q

Omphalocele

A

Covering sac of peritoneum over the protruding bowel

- Over half occur with cardiac or neural tube defects, or trisomies

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170
Q

Gastroschisis Occurrence

A

Isolated defect >90% of the time
Elevated AFP
Abdominal wall defect due to vascular insult
Uncovered bowel herniation

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171
Q

Toxic Shock Syndrome

A

Rapid onset rash (desquamating, hands and soles), fever, hypotension, diarrhea, thrombocytopenia
- Staph Aureus, superantigen TSST-1
50% aw/ tampon use, the rest with surgical wound, sinusitis, nasal packing

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172
Q

MC cause of Osteomyelitis

A

Staph Aureus (in both infants and children)
Staph epidermis is a common cause in prosthetic devices
Salmonella is common in Sickle cell patients

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173
Q

Thalamic Hemorrhage

A

Contra hemiparesis and hemisensory loss

Upgaze palsy, eyes deviate toward hemiparesis

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174
Q

Cerebral Hemorrhage

A 
Contra hemiparesis (frontal)
Contra  hemisensory loss (parietal)
Homonymous hemianopsia (occipital)
Eyes deviate away from hemiparesis
Seizure common
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175
Q

Pontine Hemorrhage

A

Deep coma, total paralysis

Pinpoint reactive pupils

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176
Q

MC cause of AR in young adults

A

Congenital bicuspid aortic valve in developed countries

Rheumatic Heart disease in developing countries

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177
Q

Anion Gap =

A

Na - (HCO3 + Cl)

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178
Q

Disseminated MAC

A

Fever, cough, diarrhea, night sweats, weight loss
Splenomegaly
Elevated Alk Phos
CD4 count

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179
Q

Paget Disease of Bone

A

Elevated Alk Phos, Normal Ca and P, Elevated Urine hydroxyproline
Osteolytic and sclerotic bone lesions
Disordered osteoclastic bone resorption
Enlargement of skull, hearing loss, frontal bossing
Tx: Bisphosphonates (inhibits osteoclasts, suppress bone turnover)

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180
Q

Behcet Syndrome

A

Young adults, turkish, middle eastern or asian
Recurrent oral aphthous ulcers
Genital Ulcers
Commonly have uveitis, skin lesions, or thrombosis
Pathergy: exaggerated skin ulceration from minor taruma

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181
Q

Condyloma Lata

A

Raised grey white mucosal lesions

Seen in syphilis

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182
Q

Epitrochlear Lymphadenopathy

A

Pathognomonic for syphilis

- Sailor’s handshake

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183
Q

Central Cord Syndrome

A

Upper extremity weakness, loss of pain temp sensation in arms
- Typically with Hyperextension injuries in elderly patients with pre-existing degenerative changes in cervical spine
Selective damage to the central portion of the corticospinal tract and decussating fibers of lateral spinothalamic tract

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184
Q

Brown Sequard Syndrome

A

Cord Hemisection
Ipsi: weakness, spasticity, loss of vibration and proprioception
Contra: pain and temp loss (lower do to lazy crossing)

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185
Q

Cervical Actinomycosis

A

Dental caries, infected tooth, gingivitis, diabetes, etc
Non-tender indurated abscess, draining sinus tract
MC in the mandible
Anaerobic Gm + filamentous branching, yellow granular pus
Tx: Penicillin

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186
Q

Nocardia

A

Aerobic Gm+ partially acid fast filamentous rod
Affects brain, soft tissue/skin, and lungs of immunocompromised
Fever and purulent crusting lesions/ulcers following traumatic inoculation
Tx: Trimethoprim-sulfamethoxazole

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187
Q

Vitamin D Deficiency

A

Low Calcium and Phosphorus
High PTH
May have bone pain, muscle weakness, cramps, gait abnormalities
May be asymptomatic

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188
Q

Acid Base: Post op Atelectasis

A

Hyperventilate to compensate
Repiratory alkalosis
Hypocapnia and Hypoxemia

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189
Q

Becks Triad

A

Seen with Cardiac Tamponade

Distended neck veins, Distant Heart sounds, Hypotension

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190
Q

Preterm Labor: 34 to 36 weeks

A

+/- Betamethasone; PCN if GBS + or unknown

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191
Q

Preterm Labor: 32 to 33 weeks

A

Betamethasone, Tocolytics, PCN if GBS+ or unknown

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192
Q

Preterm Labor:

A

Betamethason, Tocolytics, Mag Sulfate, PCN if GBS+ or unknown

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193
Q

Vanishing Bile Duct Syndrome

A

Progressive destruction of intrahepatic bile ducts
(ductopenia)
PBC is MC cause in adults

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194
Q

Amiodarone Side effects

A 
Sinus bradycardia, heart block
QT prolongation with risk of Torsades
Chronic interstitial pneumonitis (MC)
Elevated transaminases/hepatitis
Thyroid problems, Optic neuropathy, blue gray skin color, peripheral neuropathy
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195
Q

Adult Still’s Disease

A

Recurrent high fever
Rash (maculopapular, on trunk and extremities)
Arthritis

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196
Q

Acute Bacterial Rhinosinusitis

A

Persistent symptoms of at least 10 days without improvement
Severe symptoms with fever, face pain, and purulent nasal discharge
Worsening symptoms after 5 days of initially improving viral URI
MC S pneumo, then haemophilus, then moraxella
Tx: Amox-clav

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197
Q

Tumor Lysis Syndrome

A

Hyperphosphatemia, Hyperkalemia, Hyperuricemia

Hypocalcemia (prolonged QT)

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198
Q

External Cephalic Version

A

Can be offered for a singleton pregnancy is at least 37 weeks
No contraindication to vaginal delivery (placenta previa, active herpes)
No ruptured membranes, abnormal FHT, or oligohydramnios

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199
Q

Schizoaffective

A

Delusion or hallucinations in the ABSENCE of major mood disorder (depressive or manic)

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200
Q

Common Causes of Decrease Platelet Production

A

EBV, HIV, HepC
Chemo, Myelodysplasia (>60yrs), Alcohol
Fanconi Syndrome
B12 or Folate deficiency

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201
Q

Common Cause of Platelet Destruction or Sequestration

A

SLE, Heparin, ITP, DIC, TTP, HUS
Sequestration by Spleen
(May be false if clumping of platelets)

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202
Q

Meniere Disease

A

Recurrent episodes of vertigo
Hearing loss or tinnitus (Unilateral)
Elevated endolymph pressure

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203
Q

BPPV

A

Brief episodes of vertigo
Triggered by head movement
Nystagmus with Dix Hallpike
Can correct with Epley maneuver

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204
Q

Vestibular Neuritis

A

Acute, single episode (may last days)

Often following viral syndrome

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205
Q

Giant Cell Tumor

A

Soap bubble appearance (lytic expansile area) in Epiphysis
Benign, locally aggressive neoplasm in young adults
MC in distal femus, proximal tibia
Pain, swelling, decreased range of motion
Pathologic fractures may occur

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206
Q

Osteitis Fibrosa Cystica

A

MC due to hyperparathyroidism from parathyroid carcinoma
Fibrous tissue (brown tumors), causes bone pain
Subperiosteal bone resorption on radial aspect of the middle phalanges, salt pepper appearance

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207
Q

Osteoid Osteoma

A

Sclerotic, cortical lesion with a central nidus lucency
Worse at night
Quickly relieved by NSAIDs

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208
Q

Granulomatosis with Polyangiitis (Wegeners)

A

upper respiratory infections, lung nodules/cavitation
Rapidly progressive glomerulonephritis
C-ANCA (PR3)
Small medium sized vessel vasculitis

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209
Q

Imaging if Suspicious for Stroke

A

Non contrast head CT

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210
Q

Cholesteatomas

A

In children, either congenital or acquired due to chronic middle ear disease
New onset hearing loss or chronic ear drainage
Granulation tissue and skin debris in ear canal
Retraction pockets of tympanic membrane

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211
Q

Hydrocele

A

Cystic scrotal mass that transilluminates
Most disappear spontaneously by 1 yr of age
Fluid within processus or tunica vaginalis

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212
Q

Pneumonia in Cystic Fibrosis

A

Staph Aureus MC in children

Pseudomonas MC in adults

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213
Q

Trichinellosis

A

Ingestion of undercooked meat (usually pork) - roundworm infection
More in Mexico, China, Thailand, etc
Encysted larvae become worms –> larvae encyst in striated muscle
Intestinal stage: asymptomatic or abd pain, N/V, diarrhea
Muscle stage: fever, splinter hemorrhages, conjunctival/retinal hemorrhages, periorbital edema, chemosis,
Myositis (neck arm shoulder tenderness/weakness)
Eosinophilia - Hallmark

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214
Q

Ascariasis

A

Intestinal symptoms and eosinophila
Lung phase with a nonproductive cough followed by an intestinal phase
Worms may obstruct small bowel or bile ducts

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215
Q

Dengue Fever

A

Fever, headache, retroorbital pain, rash
Significant myalgia and arthralgia
May be hemorrhagic (hemorrhage in skin or nose)

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216
Q

Typhoid Fever

A

Over 3 weeks: Abdominal pain, salmon colored rash, then hepatospenomegaly and abdominal complications (bleeding)

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217
Q

Necrotizing Surgical Site

A

Pain, edema, erythema, Fever, hypotension or tachycardia
Paresthesia at edges of wound
Purulent, cloudy gray discharge (dishwater drainage)
Subcutaneous gas or crepitus
Usually polymicrobial, MC in diabetics
Tx: surgical debridements and antibiotics

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218
Q

Treatment for Pneumocystis Jiroveci

A

Trimethoprim-Sulfamethoxazole

Adjunctive corticosteroids may decreased mortality in severe cases (steroid indicated if PaO2 35)

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219
Q

Choanal Atresia

A

Cyanosis aggravated by feeding (can’t breathe through mouth)
Relieved (turn pink) with crying
Isolated or may be part of CHARGE syndrome

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220
Q

Pregnancy Visible on U/S

A

B-hCG of 1500-2000

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221
Q

Treatment for Symptomatic Endometriosis

A

OCPs and NSAIDs, if this fails, laparoscopy

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222
Q

Chronic Mesenteric Ischemia

A

Atherosclerosis of mesenteric arteries
Crampy postprandial epigastric pain (POOP)
Food aversion and weight loss
CT angiography for diagnosis

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223
Q

Treatment of Diabetes Insipidus

A

Desmopressin

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224
Q

Treatment of SIADH

A

Remove cause if possible
Fluid restriction
If severely symptomatic hyponatremia, give hypertonic saline
Demeclocycline decreases response to ADH, rarely used

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225
Q

Mixed Cryoglobulinemia

A

Due to Chronic Hep C
Palpable purpura - Vasculitis of skin, kidney, nerves, and joints
Porphyria cutanea tarda (vesicles, lesions on back of hands)
Glomerulonephritis, Arthralgia
Low complement, elevated Rheumatoid factor and LFTs

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226
Q

FSGS

A

Like minimal change, but in adults (foot process effacement)
Segmental sclerosis and hyalinosis
African americans and hispanics
Aw/ HIV, Sickle cell, Heroin

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227
Q

Membranous Nephropathy

A

Spike and dome
MC in caucasian adults
Aw/ SLE, Hep B and C, NSAIDs, solid tumors

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228
Q

Minimal Change Disease

A

Effacement of foot processes
MC in children
Aw/ Hodgkins lymphoma

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229
Q

Amyloidosis

A

apple green birefringence (congo red)

Aw/ MM, TB, RA

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230
Q

MPGN

A

Subendothelial deposits, tram tract
Aw/ Hep B and C
Low C3

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231
Q

Diabetic Glomerulonephropathy

A

Kimmelstiel WIlson nodules
GBM thickening
Mesangial espansion

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232
Q

Post Strep GN

A

Weeks after Group A strep infection (skin or pharynx)

Dark urine, periorbital edema

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233
Q

RPGN (Crescenteric)

A

Goodpasture, Wegeners (PR3, c-anca), Microscopic polyangiitis (MPO, p-anca)

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234
Q

DPGN

A

Wire looping

Aw/ SLE (MC cause of death)

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235
Q

IgA Nephropathy

A

Mesangial IgA deposits
Few days after URI or acute gastroenteritis
Seen with HSP

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236
Q

Central Adrenal Insufficiency

A

Suppression of HPA axis due to chronic glucocorticoid use
Suppresses ACTH and adrenal function, so when steroid stopped takes months to recover
Will have low cortisol and low ACTH (adrenals have not woken up)
Aldosterone levels will be normal (RAAS)

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237
Q

Testing for Syphilis

A

VDRL (non-treponemal) may be negative in early disease
FTA-ABS (treponemal) has higher sensitivity can can be used even if VDRL is negative
Could also do darkfield microscopy to look at treponema pallidum

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238
Q

Milk Protein Induced Enterocolitis

A

Fam Hx of allergies, eczema, or asthma
Age 2-8 wks, regurgitation/vomiting, painless bloody stools, eczema
Eliminate milk and soy from maternal diet (if breastfeeding)
Hydrolyzed formula in formula fed infants
Resolves by 1 yr of age

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239
Q

Rotator Cuff Impingement or Tendinopathy

A

Pain with abduction, external rotation, positive impingement tests (Neer and Hawkins)

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240
Q

Adhesive Capsulitis

A

Frozen shoulder
Decreased passive and active ROM
More stiffness than pain

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241
Q

Biceps Tendinopathy or Rupture

A

Anterior shoulder pain, pain with lifting/carrying/overhead reaching

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242
Q

HIV Screening in Pregnancy

A

All women should be screened in First Trimester
Because of window period, should screen again in Third Trimester
Infants diagnosed with PCR testing

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243
Q

Basal Ganglia (Putamen) Hemorrhage

A

Conta hemiparesis (internal capsule) and hemisensory loss
Homonymous hemianopsia
Gaze palsy towards lesion

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244
Q

Side effects of EPO therapy in ESRD

A

Worsening of HTN (1/3 of patients)
Headaches
Flu symptoms
Red cell aplasia (rare)

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245
Q

Congenital CMV

A

Blueberry muffin spots, periventricular calcifications

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246
Q

Congenital Toxoplasmosis

A

Diffuse intracerebral calcifications

Chorioretinitis

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247
Q

Congenital Syphilis

A

Rhinorrhea (snuffles), Abnormal long bone radiographs
Desquamating or bullous rash
Hutchinson teeth, saber shins, saddle nose

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248
Q

Congenital Rubella

A

Cataracts
PDA
Deafness
Blueberry muffin rash

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249
Q

Cerebral Palsy

A 
Increased risk with prematurity (before 32 wks especially)
Nonprogressive motor dysfunction
3 types: spastic, dyskinetic, and ataxic
Clasp knife spasticity
50% have intellectual disability
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250
Q

Suspected Infection in Neonate

A

Poor feeding, decreased alertness, lethargy, fever or hypothermia
Full evaluation: CBC, blood cultures, LP, urinalysis, urine culture
Start empiric antibiotics

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251
Q

Clavicular Fracture Evaluation

A

Careful neurovascular exam is important due to proximity to subclavian vein and brachial plexus
- If bruit heard, do angiogram

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252
Q

Femoral Nerve

A

IPSQuad muscles

Sensation to anterior thigh and medial leg

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253
Q

Tick Borne Paralysis

A

Rapidly progressive ascending paralysis (may be asymmetrical)

  • No fever, sensory issues
  • Normal CSF
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254
Q

Chlordiazepoxide

A

Benzo used for Alcohol withdrawal

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255
Q

Dermatofibroma

A

Benign fibroblast proliferation
Firm hyperpigmented nodule (usually on LE)
When pinched, causes dimpling (buttonhole sign)

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256
Q

Duchennes Muscular Dystrophy

A

Absent dystrophin gene

Dx: muscle biopsy, genetic testing is gold standard

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257
Q

Becker’s Muscular Dystrophy

A

Decreased (but not absent) dystrophin
Muscle weakness later in childhood
Milder version of Duchennes

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258
Q

Myotonic Dystophy

A

AD; presents in teen years
Muscle weakness, myotonia, cataracts, cardiac problems
Delayed muscle relaxation
Electromyography - myotonic pattern

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259
Q

Risk for C Diff

A

Advanced age, recent abx use (clindamycin, penicillins, cephalosporins, FQs), hospitalization, prolong acid secretion by PPIs

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260
Q

Treatment for Kawasakis

A

Aspirin + IVIG

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261
Q

Asymmetric Fetal Growth Restriction

A

Maternal cause

HTN, Pre-E, DM, SLE, substance abuse

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262
Q

Symmetric Fetal Growth Restriction

A

Fetal Factor
Genetic disorder
Congenital heart defect
Intrauterine infection

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263
Q

Peripheral Precocious Puberty (Gonadotropin Independent)

A

LH low at baseline, Does not increase with GnRH
Advanced bone age, coarse axillary and pubic hair, cystic acne
Late-onset (nonclassic) CAH

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264
Q

Idiopathic Precocious Puberty

A

Premature HPG activation
Almost exclusively in girls
LH elevated at baseline, Increases with GnRH

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265
Q

Leydig Cell Tumors

A

Gonadotropin independent precocious puberty

Unilateral testicular enlargement or mass

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266
Q

Treatment for Restless Leg Syndrome

A

Dopamine Agonists
Pramipexole or Ropinerole
May need oral iron supplementation
Can try using Gabapentin

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267
Q

PCOS Cancer Risk

A

Unbalanced estrogen

Endometrial hyperplasia and risk of endometrial cancer

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268
Q

pH of Exudate and Transudate

A

Transudate: 7.4-7.55
Exudate: 7.3-7.45
Normal Pleural Fluid: 7.6

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269
Q

Pleural fluid glucose

A

Usually in complicated parapneumonic effusion, malignancy, TB, or RA

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270
Q

Evaluation of Cushing’s Syndrome

A

Initial: late night cortisol, 24 hr urine free cortisol, and/or low dose dexamethasone suppression
If hypercortisolism: ACTH level measured (to see if dependent or independent)
If ACTH suppressed/independent: CT scan adrenals
If ACTH elevated/dependent: High dose dexamethasone (to determine if pituitary or ectopic)
Ectopic: Dexa will not suppress cortisol
Pit: Dexa suppresses cortisol

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271
Q

Migratory Superficial Thrombophlebitis (Trousseau)

A

Usually aw/ occult malignancy (pancreatic cancer)

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272
Q

Management of a Threatened Abortion

A

Symptoms resolve or progression to inevitable, incomplete, or missed abortion

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273
Q

Incomplete, Inevitable, or Missed Abortion Management

A

If hemodynamically unstable (heavy bleeding): D&C surgical evacuation
If hemodynamically stable (mild bleeding): Patient preference between –> Expectant management, Medical-prostaglandins, or Surgical evacuation

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274
Q

Septic Abortion Management

A

Blood and endometrial cultures
Broad spectrum abx
Surgical evacuation

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275
Q

Management of a Stable Ectopic Pregnancy

A

Methotrexate

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276
Q

Neonatal Tetanus

A

Poor suckling, fatuge, then rigidity and spasms
Fatal if untreated
Infants born to unimmunized mothers
Often have umbilical stump infection

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277
Q

Central Precocious Puberty

A

Increased FSH and LH due to early activation of HPO axis
Need brain imaging with CT or MR
Tx: GnRH analog

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278
Q

Osgood Schlatter Disease

A 
Traction Apophysitis (soft tissue swelling, irrgular/fragmented tubercle)
In adolescents playing sports
Tenderness over tibial tubercle
Tx: activity restriction, stretching, NSAIDs
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279
Q

Patellar Tendonitis

A 
Overuse injury (jumping or kicking)
Anterior knee pain (no point tenderness)
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280
Q

HIV and Live Vaccines

A

Most contraindicated EXCEPT MMR and Varicella zoster

- can be given if CD4 count >200 and no hx of AIDs defining illness

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281
Q

Shy Drager Syndrome

A

Multiple system atrophy

  • Parkinsonism
  • Autonomic Dysfunction
  • Widespread neurological signs (cerebellar, pyramidal, LMN)
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282
Q

Antiphospholipid Syndrome

A

Higher frequency in SLE
VTE or recurrent early miscarriage
Pro-thrombotic immunoglobulin (in vivo) –> causes prolonged PTT in vitro

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283
Q

Diabetes Screening

A

All patients 45 or older, and those at any age who have additional risk factors
-Fasting plasma glucose
HA1C or OGTT

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284
Q

Hyper IgM

A

Elevated IgM, low IgA and IgG
X linked defect in CD40 ligand
Recurrent infections
Tx: Abx ppx and interval IVIG

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285
Q

Metoclopramide Induced Dystonic Reaction

A

DA antagonist used to treat N/V and gastroparesis
EPS can occur
Tx: discontinue medication, benztropine or duphenhydramine

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286
Q

Prosthetic Joint Infection

A

Within 3 months: staph aureus

After 3 months: staph epidermis

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287
Q

Serotonin Syndrome

A

Hyperreflexia and myoclonus present (unlike in NMS)

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288
Q

Infectious Mono

A

EBV, fever, fatigue, exudative pharyngitis, and cervical lymphadenopathy
Polymorphous maculopapular rash develops with administration of amoxicillin

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289
Q

Klumpke’s Palsy

A

Claw hand (extended wrist, hyperextended MCP, flexed interphalangeal joints)
Due to shoulder dystocia
Damage to C8 and T1
Abnormal grasp, Normal moro

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290
Q

Erb Duchenne Palse

A

MC type of brachial plexus injurt
5th and 6th cervical nerves
Waiter tip
Normal grasp, Abnormal Moro

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291
Q

Young healthy patient with CHF

A

Myocarditis is likely, due to a Viral infection

- With a coxsackie B virus is MC cause

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292
Q

Anemia, Osteolytic lesions, Hypercalcemia

A

Multiple Myeloma
Excessive production of monoclonal proteins
Ineffective antibody production
Screen with SPEP, Confirm dx with bone marrow biopsy

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293
Q

Radioactive Iodine Uptake

A

Increased RAIU suggests de novo thyroid hormone synthesis
Decrease suggests preformed hormone release or exogenous hormone intake
- If exogenous, then thyroglobulin low
- If thyroiditis (preformed release), high thyroglobuline

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294
Q

Torus Palatinus

A

Fleshy immobile mass on the midline hard palate
Congenital
No medical or surgical therapy unless symptomatic or interfering with speech/eating

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295
Q

Acid Base: Chronic COPD

A

Normal pH, elevated HCO3

If acute CO2 retention, then HCO3 near normal levels and decreased pH

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5
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296
Q

Treatment for Bipolar Disorder

A

First Line: lithium or valproate with a 2nd gen antipsych
Approved: Lithium, valproate, quetiapine, and lamotrigine
Avoid antidepressants
Do not use lithium if impaired renal function

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297
Q

Dumping Syndrome

A

Common postgastretomy complication
Abd pain, diarrhea, nausea, hypotension 15-30 min after meals due to rapid emptying of hypertonic gastric contents
Tx: small frequent meals, complex carbs, high fiber and protein

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298
Q

Complete Mole

A

2 sperm fertilize an ovum without genetic material
No fetal tissue
Hyperemesis gravidarum , enlarged uterus, theca lutein ovarian cyts

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299
Q

Incomplete Mole

A

2 sperm fertilize a haploid ovum

Fetal tissue, triploid karyotype

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300
Q

Resuscitative vs Maintenance Fluids

A

Resuscitative: D5 never used, only NS or LR (isotonic crystalloids); DO not use 1/2or 1/4 NS (hypotonic)
Maintenance: D5 can be added

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301
Q

Treatment of Hip Dysplasia in Infants

A

Tx: pavlik hip harness if

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302
Q

Serous Otitis Media

A

Non infectious effusion, MC middle early pathology in AIDs patients
Due to lymphadenopathy or obstructing lymphomas
- Conductive hearing loss is MC symptom
- Dull TM that is hypomobile

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303
Q

Lead Poisoning in Adults

A 
Occupational exposure (lead paint, batteries, construction)
Abd pain, constipation, anorexia, cognitive deficits, peripheral neuropathy, Anemia
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304
Q

Microangiopathic Hemolytic Anemia

A

HUS following diarrheal syndrome from E coli 0157H7
Purpura, HTN, renal failure, oliguria, thrombocytopenia, fever
Schistocytes on peripheral smear
Elevated LDH and indirect bili

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305
Q

SCID

A

Failed T cell development and dysfunctional B cells as a results of absent T cells
X linked recessive or AR
Recurrent infection, FTT, chronic diarrhea

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306
Q

Chronic Granulomatous Disease (CGD)

A

NADPH oxidase defect, impaired killing of catalase+ organisms (eg. staph aureus)
Phagocytes filled with bacteria
Recurrent skin and soft tissue infections
Normal lymphocytes and immunoglobulins
Dx: DHR or NBT tests to test neutrophil function

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307
Q

CVID

A

Recurrent sinopulmonary or GI bacterial infections
Hypoglobulinemia
Unlike Bruton agammaglobulinemia, it is less severe, presents later, and has normal B cell counts

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308
Q

Bruton (X-Linked) Agammaglobulinemia

A

Absern B cells, low serum immunoglobulins
Normal T cell concentration
Recurrent infection
Absent lymphoid tissue

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309
Q

Burr Cells

A

Spiculated RBCs (serrated edges) seen in liver disease and ESRD

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310
Q

Howell Jolly Bodies

A

Splenectomy patients or patients with functional asplenia (sickle cell)

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311
Q

Treatment of Sinus Bradycardia

A

IV Atropine

If inadequate response, IV epi or dopamine, or trancutaneous pacing

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312
Q

Chronic CO Poisoning

A

Intermittent headaches, dizziness, nausea, polycythemia due to hypoxemia
Carboxyhemoglobinemia
- Exposure to automobile exhaust

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313
Q

Vit D Deficiency (Rickets)

A
  • Rachitic rosary: Enlarged protruding costochondral joins
  • Delayed fontanel closure, craniotabes
  • Genu varum, bowing, metaphyseal cupping
  • Hyperpigmentation
  • Usually due to exclusive breastfeeding/homemade food
    Normal to low Ca and P, Elevated Alk Phos and PTH
314
Q

Meniscal Tear

A

Passive knee flexion (McMurray) and extension while in itnernal adn external rotation
Pain, clicking, or catching, sensation of instability
Usually from twisting force with foot fixed

315
Q

Pendular Knee Swing Reflex

A

Indicates muscular hypotonia

May be seen with cerebellar dysfunction (other signs include gait instability, ataxia, intention tremor)

316
Q

Acetaminophen Ingestion

A

If less than 4 hrs, give charcoal and check level (nomogram)

- Give N acetylcysteine and monitor for liver injury

317
Q

Transfusion Reactions: Febrile Non-Hemolytic

A

MC, 1-6 hrs, fever chills, from cytokines (prevent with leukoreduction)

318
Q

Neonatal Thyrotoxicosis

A

Transplacental anti-TSH receptor antibodies
- bind infants TSH receptors causing excessive hormone release
- Watm, tachycardia, irritable, low weight
Self resolves in 3 months, or methimazole + B-blocker

319
Q

MCL Tear

A

Laxity with valgus stress
Blow to lateral kneww or twist injury
If uncomplicated: RICE and analgesics
Complicated need surgery

320
Q

Common bacterial trigger of SJS

A

Mycoplasma pneumonia

321
Q

Baseline Studies Needed Before Starting Lithium

A

Creatinin/BUN and Thyroid function tests

Calcium, U/A, and maybe ECG

322
Q

Diamond Blackfan Syndrome

A

Congenital Macrocytic anemia

Congenital anomalies: short stature, webbed neck, cleft lip, shield chest, triphalangeal thumbs

323
Q

CMV Retinitis

A

Painless, not aw/ keratitis or conjunctivitis
MC ocular complication in HIV patients
Fluffy or granular lesions around retinal vessels

324
Q

HSV and VZV Keratitis

A

Pain and may show peripheral pale lesions and central retinal necrosis
Rapidly progressing bilateral necrotising retinitis

325
Q

Electrolyte Disturbances: Vtach

A

Hypokalemia or Hypomagnesemia

May be due to diuretic use

326
Q

Amebic Liver Abscess

A

Fever, pain, leukocytosis, Emigated from Mexico
Hx of dysentery, likely Entamoeba Hystolytica
Tx: Metronidazole (oral), may also need a luminal agent (parrmomycin)

327
Q

Hydatid Cyst

A

Echinococcus, pyogenic bacterial abscess
Frequently asymptomatic
Requires animal contact (dogs,sheep)

328
Q

Unexplained elevation of CK and Myopathy

A

Suspect Hypothyroidism

329
Q

Risk of Sepsis post-splenectomy

A

Risk present for up to 30 years
Should get anti-pneumococcal, haemophilus, and miningococcal vaccines several weeks before operation
Daily oral PCN ppx for 3-5 years following splenectomy

330
Q

Malaria PPx:

Sub-saharan Africa and Southeast Asia

A

If Chloroquine resistant P falciparum: Atovaquone-proguanil, Doxy, or Mefloquine (use in pregnancy)
If sensitive: above or chloroquine, hydroxychloroquine

331
Q

Malaria PPx: Areas without P Falciparum

South America, Mexico, Korean Peninsula

A

Primaquine

332
Q

Treatment for Social Anxiety Disorder

A

SSRIs or SNRIs (first line) and CBT

Beta blockers for performance only social anxiety

333
Q

Bicuspid Aortic Valve Murmur

A

Systolic click followed by a fain midsystolic murmur

334
Q

Adult - Late Presentation of Coarctation

A

Upper extremity HTN, may have chest pain, headache, claudication
Diminished femoral pulses with brachial femoral delay
Continuous cardiac murmur
Rib notching

335
Q

Supratentorial Tumors

A

Elevated ICP and seizures

336
Q

Posterior Fossa Tumors

A

Elevated ICP, ataxia, clumsiness

337
Q

Pilocytic Astrocytoma

A

MC brain tumor in children

338
Q

Medulloblastoma

A

2nd MC tumor of posterior fossa in children

339
Q

PPSV23 and PCV13 Recommended for:

A

PPSV alone: Adults under 65 w/ chronic condition
(heart or lung disease, diabetes, smoking, or liver disease)
PCV then PPSV: Adults under 65, w/ high risk condition
(CSF leak, Sickle cell, Asplenia, renal fail, immunocomp)
PCV then PPSV after 6-12 mo: ALL adults over 65

340
Q

Acute Rheumatic Fever

A

Migratory arthritis, carditis, subcut nodules, erythema marginatum, syndenhams chorea
fever, arthralgia, ESR,CRP, prolonged PR

341
Q

Treatment for Uremic Encephalopathy

A

Urgent Dialysis

342
Q

Organophosphate Poisoning

A

Acetylcholinesterase inhibited –> Cholinergic excess
Bradycardia, miosis, salivation, lacrimation, diarrhea, urination
Tx: Atropine will counteract effects

343
Q

PCOS

A

Elevated LH–> excess androgens
Anovulation, male pattern hair growth, acne, ovarian cysts
Aw/ obesity, insulin resistance

344
Q

Pediatric Viral Myocarditis

A 
Coxsackie B or Adenovirus
Viral prodrome followed by heart failure
Cardiomegaly and pulmonary edema
High mortality in newborns
Dx: biopsy
345
Q

Class IC Antiarrhythmics

A

Sodium channel blockers (eg flecainide)
- can be used to treat a fib
Use dependence
Less time to dissociate with fast HR, can lead to QRS widening

346
Q

Case Control

A

Observation study
Retrospectively associates outcomes with specific risks
Determine the outcome and look for associated risk factors

347
Q

Cross Sectional Studies

A

Observational study
Assess both exposure and outcome at a single point in time
Can show association, not causation

348
Q

Prospective Cohort Study

A

Observational study

Exposed and Unexposed groups followed for development of a disease

349
Q

Retrospective Cohort Study

A

Risk factor exposure and outcome of interest occur in past, and assessed through review of records

350
Q

Randomized control trial

A

Experimental study to study efficacy of a treatment or procedure

351
Q

Evaluation of Adrenal Insufficiency

A

ACTH Cosyntropin stimulation test with cortisol and ACTH level
If basal cortisol low, and ACTH high, with minimal response –> Primary adrenal insuff
If basal cortisol low and ACTH low, and inadequate response –> Secondary adrenal insuff

352
Q

Interstitial Cystitis

A

Painful bladder syndrome
Idiopathic (aw/anxiety and fibtromyalgia), chronic
Worse with filling, relieved by voiding
Dyspareunia, urinary frequency/urgency

353
Q

Hysterosalpingogram

A

To assess if there is tubal obstruction or patency

Especially in patients with hx of PID and current infertility

354
Q

Number Needed to Treat (NNT)

A

1/ARR

355
Q

Prinzmetal Angina

A

Chest pain due to coronary vasospasm
Young females, smoking is a risk factory
Episodes usually at night, transient ST elevations
Tx: CCBs, nitrates, stop smoking

356
Q

Pseudoachalasia

A

Achalasia due to esophageal cancer
Older age, weight loss, hx of smoking
Will need to do Endoscopy to exclude malignancy
CT after for staging

357
Q

Bupropion

A

NE DA reuptake inhibitor

No weight gain or sexual size effects

358
Q

Intraductal Papilloma

A

Unilateral bloody nipple discharge
No mass or lymphadenopathy
Benign

359
Q

Infiltrating Ductal Carcinoma

A

Pathologic nipple discharge
Corresponding breast mass and lymphadenopathy
Microcalcifications

360
Q

Amyloidosis and RA

A

AA amyloidosis
Abnormally dolder proteins, Beta 2 microglobulin
Nephrotic syndome: edema, proteinuria
Enlarged kidneys and Hepatomegaly

361
Q

MC cause of AL amyloidosis

A

Multiple Myeloma

362
Q

MC cause of AA amyloidosis

A

RA

363
Q

Managing Stroke in Sickle Cell Patient

A

Stroke secondary to sludging and occlusion
Exchange transfusion recommended acutely
Prevents second infarct
Fibrinolytic, Heparin, or Warfarin are not helpful since there is not a true thrombus

364
Q

Nocardia

A

Filamentous, aerobic, Gm+
Partially acid fast
Pulmonary or disseminated disease to brain
Tx: TMP-SMX

365
Q

Papillary Necrosis

A

Renal complication from Sickle cell trait
Massive hematuria, mild episodes that resolve spontaneously
U/A: normal appearing RBCs

366
Q

Managing Blunt Trauma to Spleen

A

If hemodynamically unstable and unresponsive to fluids: emergent ex laparotomy
If responsive to fluids: Abd CT to see if operative intervention is needed
- Effort to repair in children and avoid removal
- If removed, need vaccines against encapsulated bacteria

367
Q

Allergic Interstitial Nephritis

A

Acute renal failure
Recent use of sulfonamide/NSAIDs/PCNs
Fever, rash
WBC casts and eosinophiluria

368
Q

Rivaroxaban

A

Direct factor Xa inhibitor
Efficacy similar to heparin and LMWH in treating acute DVT or PE
Does not need frequent lab monitoring or daily injections
No reversal antidote

369
Q

Recurrent pneumonia in same anatomic region

A

Suggests bronchial obstruction due to an underlying abnormality
Chest CT indicated to visualize parenchyma

370
Q

Elevated Inhibin A

A

Trisomy 21

371
Q

Decreased Estriol

A

Trisomy 18 and 21

372
Q

Increased B-hCG

A

Trisomy 21

373
Q

Decreased AFP

A

Trisomy 18 and 21

374
Q

Trachoma

A

By Chlamydia serotype A-C
Major cause of blindness worldwise
Follicular conjunctivitis and pannus (neovascularization) formation of the corner
Concurrent infection in nasopharynx (nasal discharge)
Tx: topical tetracycline or oral azithro

375
Q

DHEA

A

Elevated in patients with androgen producing adrenal tumors

376
Q

Contact Dermatitis

A

Type IV hypersensitivity - T cell lymphocyte mediated

377
Q

Side Effect of Idinavir (Protease Inhibitor), Acyclovir, Ethylene glycol, Methotrexate

A

Crystal induced nephropathy

- Renal Tubular Obstruction

378
Q

Smudge Cells

A

Seen with CLL with small mature lymphocytes

379
Q

Treatment for Chemo-induced nausea

A

Serotonin (5HT) Receptor Antagonists (first line)

- Ondansetron

380
Q

Intermittent Asthma

A

Daytime

381
Q

Mild Persistent Asthma

A

Daytime >2x week, Nighttime >2x month

-Low dose steroid, SABA

382
Q

Moderate Persistent Asthma

A

Daytime daily, Nightitme weekly

  • High dose steroid, SABA
  • Low dose steroid, LABA, SABA
383
Q

Severe Persistent Asthma

A

Symptoms throughout day and frequently at night

  • High dose steroid, LABA, SABA
  • May need oral steroid if worsening
384
Q

FHR: Sinusoidal Fetal Heart Tones

A

Smooth undulating waveform with no variability

Aw/ fetal anemia

385
Q

FHR: Early Decels

A

Occurs with contractions, fetal head compression

386
Q

FHR: Late Decels

A

Uteroplacental Insufficiency

387
Q

FHR: Variables

A

Compressed cord or Prolapsing cord

388
Q

Lowering a Screening Tests Cuttoff Point

A 
Increases Sensitivity (disease+ will test + --> less false negatives)
Decreases Specificity (disease- will test - -->more false positives)
389
Q

Treatment for Torsades

A

If stable, IV mag

If unstable, immediate defibrillation

390
Q

Gilbert’s Syndrome

A

Unconjugated hyprbilirubinemia
Decreased UDP glucoronyl transferase enzyme
Usually asymptomatic
Fasting, crash diets, fever, physical exertion, stress, and fatigue are triggers

391
Q

Crigler Najjar Syndrome

A

Unconjugated hyperbilirumbinemia
Severe jaundice and neurologic impairment due to kernicteris
Type 2 is a milder form

392
Q

Rotor Syndrome

A 
Conjugated hyperbilirubinemia (in urine) - Benign condition
Defect in hepatic storage of conjugate bilirubin --> leakage into plasma
393
Q

Giardiasis

A

International travel, diarrhea, cramping, foul smelling stools, bloating
Benign abd exam

394
Q

IVDA - Infective Endocarditis

A

MC due to staph aureus
Tricuspid valve, holosystolic murmur
Tx: Vancomycin
(cover for MSSA, MRSA, strep, and enterococci)

395
Q

Acute Limb Ischemia Post-MI

A

Suggests possible arterial embolis from LV thrombus
Get transthoracic Echo to look for thrombus in LV
Immediate anticoagulation, vascular surgery

396
Q

Abx Prophylaxis for Rheumatic Fever

A

Penicillin for Whichever is longer
5 yrs or until age 21: RF without carditis
10 years or until age 21: RF with carditis no valve disease
10 years or until age 40: RF, carditis, and valve disease

397
Q

G6PD activity

A

Normal during an acute episode becuase the G6PD deficient RBCs have been hemolysed early, reticulocytes have normal enzyme levels

398
Q

Infective Endocarditis - Valve

A

MC affects Mitral valve (MVP with mitral regurg, RHD mitral stenosis)
Aortic vave is 2nd MC involved (bicuspid, with aortic stenosis)

399
Q

Studies looking at Disease Incidence

A

Cohort

400
Q

Studies looking at Disease Prevalence

A

Cross Sectional

401
Q

Studies looking at Risk Factor Frequency

A

Case Control

402
Q

Paroxysmal Nocturnal Hemoglobinuria

A

Hemolysis, cytopenias, venous thrombosis (portal vein thrombosis)
Absence of CD55 and 59 - Flow cytometry
Tx: Eculizumab (inhibits complement activation), Iron and folate

403
Q

Sudden Cardiac Arrest in setting of acute MI

A

MC cause if Vfib (occurs in the first hour)

- Reentrant ventricular arrhythmia is the mechanism

404
Q

Cholesterol Embolism

A

After a vascular procedure (cardiac cath)
Livedo reticularis, Blue toe
Mesenteric ischemia, acute pancreatitis

405
Q

Abnormal Fingerstick Lead values

A

Confirm with a venous blood draw

406
Q

Specialized RBC treatments

A

Irradiate: for BMT patients, immunodeficient patients
Leukoreduction: CMV seronegative at risk patients, potential transplant pts, previous febrile nonhemolytic reaction
Washed: IgA deficiency, allergy, complement dependent AIHA

407
Q

Antiphospholipid Syndrome

A

Commonly false positive VDRL
Thrombocytopenia and prolonged PTT
Start on LMWH during pregnancy

408
Q

Salicylate Poisoning

A

Tinnitis, fever, tachypnea
Respiratory Alkalosis followed by metabolic acidosis
Anion gap

409
Q

Uric Acid Crystals in Diaper

A

Brick dust streaks - sign of mild dehydration
Excretion seen during first week as mothers milk is coming in, or later as morning void when infant starts sleeping through night

410
Q

Leydig cell tumor

A

Elevated testosterone as well as estrogen

HbCG and AFP negative

411
Q

Primary Ovarian Failure

A

LH and FSH elevated, FSH:LH ratio >1

412
Q

Air in biliary tree

A

Emphysematous infection or Gallstone ileus (due to fistula)

413
Q

Treatment of Postpartum Endometritis

A

Polymicrobial infection

IV clindamycin + gentamicin

414
Q

Steroid Acne

A

Monomorphous pink papules and absence ofcomedones

415
Q

Bath Salt Intoxication

A

Amphetamine analog
Severe agitation, combativeness, psychosis, delirium, myoclonus
Prolonged duration of effect

416
Q

Phototherapy for Jaundice

A

If total bili >20

417
Q

Prevention of Post-SAH Cerebral Vasospasm

A

Nimodipine

418
Q

Managing Congenital Prolonged QT

A

Risk of syncope, arrhythmia and sudden death
Avoid electrolyte derangement, medications blocking potassium, and excess exertion
- Beta blockers and pacemaker placement

419
Q

Internuclear Ophthalmoplegia

A

Disorder of conjugate horizontal gaze, affected eye (ipsi to lesion) cannot adduct, and the contra eye abducts with nystagmus
Normal convergence and pupil reflex
Damage to MLF
Bilateral lesions classically seen in MS

420
Q

Fat Necrosis of the Breast

A

Fat globules and foamy histiocytes
Immobile, may have retraction of overlying skin
Appearance of Calcifications on mammography

421
Q

Amiloride

A

Potassium Sparing Diuretic

422
Q

Full Thickness Burns causing vascular compromise

A

Escharotomy, if no relief, Fasciotomy

423
Q

Tennis Elbow

A

Lateral Epicondylitis

424
Q

Golfer Elbow

A

Medial Epicondylitis

425
Q

Treatment of Lichen Sclerosis

A

After confirmed with Punch Biopsy

High potency vaginal steroid

426
Q

MC Malignancy of the Lip

A

Squamous Cell Carcinoma (SCC)

95% on lower lip

427
Q

Glucose 6 Phosphatase Deficiency

A

(NOT G6PD)
3-4 month old with hypoglycemia (may have seizures), hyperuricemia, hyperlipidemia
Lactic acidosis, doss like face (fat cheeks), thin extremities, short stature
Enlarged liver and kidneys

428
Q

CMV Infection

A

Resembled EBV mono
Fever, malaise, fatigue, mild or absent pharyngitis
Lymphocytosis with >10% atypical lymphocytes
- Negative heterophile antibody
Self limited

429
Q

PPV and Prevalence

A

PPV increases with prevalence

NPV decreases

430
Q

Septic Shock

A

Decreased Pulm Wedge pressure
Decreased SVR
Increased cardiac index
Increased Mixed Venous Sat

431
Q

Hypovolemic Shock

A

Decreased Pulm Wedge pressure
Decreased Cardiac index
Increased SVR

432
Q

Cardiogenic Shock

A

Increased Pulm Wedge Pressure
Decreased Cardiac index
Increased SVR

433
Q

Rhabdomyolysis

A

Standard U/A shows Large Blood
Microscopy shows very few RBCs
- Myoglobin not visible
Can cause Acute Renal Failure

434
Q

Transient Tachypnea vs Respiratory Distress Syndrome: CXR

A

TTN: Bilateral perihilar linear streaking
RDS: Diffuse reticulogranular (ground glass), air bronchograms, low lung volumes

435
Q

Home O2 Treatment

A

SaO2

436
Q

Lacunar Infarcts

A

Pure motor hemiparesis

Commonly occurs in internal capsule

437
Q

Amaurosis Fugax

A

Painless loss of vision due to emboli
Warning sign for impending stroke
Most emboli from carotid bifurcation
Duplex U/S should be performed

438
Q

Meningococcal Vaccine

A

All adolescents age 11-12
Should get boost between ages 16-21
Important for: Military recruits, college students, and travelers to sub Saharan Africa or Mecca

439
Q

Risk factors for Respiratory Distress Syndrome

A

Prematurity and Maternal Diabetes Mellitus

440
Q

Immunization D T P Contraindications

A

Diphtheria/tetanus: anaphylaxis
Precaution with Guillain barre, Arthus reaction
Pertussis: anaphylaxis, neurologic disorder (epilepsy, spasms), encephalopathy
Precaution with seizure, fever, hypotonia

441
Q

Beta Blocker Overdose

A

Bradycardia (AV Block), hypotension, wheezing, hypoglycemia, delirium, seizures, and cardiogenic shock
Tx: Administer IV Glucagon

442
Q

Positive Bronchodilator Response

A

> 12% increase in FEV1

Asthma - reversible

443
Q

Complicated Diverticulitis with Abscess

A

3 cm: CT guided percutaneous drainage

444
Q

Vasa Previa

A

Fetal vessels traverse the amniotic membranes over the internal os, vulnerable to tearing
- Tachycardia followed by bradycardia, eventual sinusoidal. Risk of fetal exsanguination
Risk factors: 2nd trimester u/s showing a placenta previa resolving by 3rd trimester

445
Q

Fibromuscular Dysplasia

A

MC cause of secondary HTN in children
Also in young women; low aldosterone renin ratio
Also seen in premenopausal women (renin high)
Bruit at costovertebral angle, carotid
Angiography shows string of beads

446
Q

Systemic Blastomycosis

A

-Great lakes, Upper Midwest, Mississippi, Ohio River
- Ulcerated skin lesion (wartlike, violaceous) and lytic bone lesions
- Pulmonary manifestations
- Broad based budding yeast
Tx: itraconazole or amphotericin B

447
Q

Medications causing Hyperkalemia

A

B-blockers, Potassium sparing diuretics (amiloride), ACEis, ARBs, and NSAIDs

448
Q

Central Retinal Vein Occlusion

A

Painless loss of vision, acute, unilateral
Venous dilation and tortuosity
Scattered hemorrhages and cotton wool spots
“blood and thunder” appearance

449
Q

Palpable Breast Mass: >30

A

Mammogram +/- U/S

If suspicious do Core Biopsy

450
Q

Palpable Breast Mass:

A

U/S +/- Mammogram
If simple cyst: needle aspiration
If complex cyst or mass: Core biopsy

451
Q

Magnesium Sulfate Toxicity Risk Factor

A

Renal insuffiencieny
(Mag excreted by kidneys)
Decreased DTR, somnolence, respiratory depression

452
Q

Reactive Arthritis

A

Seronegative spondyloarthropathy
Triad: Nongonnococcal urethritis, Asymmetric oligoarthritis, and conjunctivitis
Tx: NSAIDS

453
Q

Lactation Suppression

A

NSAIDs, ice packs, supportive bra, and avoid nipple stimulation

454
Q

Abrupt Cessation of Short Acting Benzos

A

eg. Alprazolam
Aw/ significant withdrawal
- Generalized seizure
- Confusion

455
Q

Serum Sickness Like Reaction

A

Type III Hypersensitivity
1-2 weeks after Beta lactam or TMP-SMX
- Fever, urticaria, polyarthrlagia

456
Q

Zinc Deficiency

A

Chronic TPM or malabsorption
Alopecia, skin lesions, abnormal taste
Impaired wound healing

457
Q

Any Penetrating Wound in Thorax Below Nipples

A

Potential to be abdominal

Requires an Ex Lap

458
Q

Side Effect of Hydroxychloroquine

A

Retinopathy

459
Q

Rash commonly seen with Mycoplasma pneumonia

A

Erythema Multiforme

Dusky red target shaped lesions

460
Q

Medications that Cause Idiopathic Intracranial Hypertension

A

Growth hormone
Tetracyclines
Excess Vit A, Isoretinoin, ATRA

461
Q

Morton Neuroma

A

Usually between 3rd and 4th toes

Clicking sensation with palpation and squeezing

462
Q

Optic Neuritis

A

Suspect in patient with central scotoma, afferent pupillary defect, change in color perception, and decreased visual acuity
- Aw/ Multiple sclerosis

463
Q

Testing for Acute Hep B infection

A

HBsAg and anti-HBc
Both elevated during initial infection
anti-HBc will be elevated during window period

464
Q

Risk of Brain Abscess with:

A

Recurrent Sinusitis
Fever, severe headaches (morning or nocturnal)
Focal neurologic changes
Seizures in 25%

465
Q

Treatment of UTIs

A

Uncomplicated: nitrofurantoin or TMP-SMX right away, don’t need urine cx
Complicated of Pyelo: need urine cx first, will probably need to use FQs

466
Q

Normal Anion Gap Acidosis and FTT

A

Renal or GI etiology
If no diarrhea, then likely RTA (alkaline urine)
Low serum bicarb, high chloride
Type 2 RTA (Fanconi) cant reabsorb bicarb
Type 1 RTA cant excrete hydrogen

467
Q

Dominant Lobe

A

Opposite side of Handedness

468
Q

Prolonged infusion of Sodium Nitroprusside

A

Cyanide toxicity
Especially in patients with CKD
Headache, confusion, flushing, arrhythmias, and respiratory depression
Tx: Sodium Thiosulfate

469
Q

Ecthema Gangrenosum

A

Pseudomonas aeruginosa infection
Rapidly progressive skin lesions that develops into nontender nodules with central necrosis (ruptured bulla leaving nontender ulcer with black center)
- Seen in immunocompromised

470
Q

Sore throat, dry cough, chest pain radiating to shoulder followed by weakness,dizziness, syncope, and pulsus paradoxus

A

Viral Myocarditis followed by Cardiac Tamponade

471
Q

Large Decrease in Systolic BP with Inspiration

A

Pulsus Paradoxus

- may have loss of radial pulse during inspiration

472
Q

Herpes Simplex Encephalitis: CSF

A

Lymphocytosis, increased protein and RBCs, normal glucose

May have seizures or bizarre psychotic behavior

473
Q

Restrictive Pulmonary Disease

A

Decreased FEV1, FVC, and TLC
Normal or Increased FEV1/FVC (since proportional decrease)
Bibasilar fine, dry crackles
May be due to Pulmonary fibrosis

474
Q

Transfusion Reaction: Anaphylaxis

A
475
Q

Transfusion Reaction: TRALI

A

Respiratory distress and hemolyis

476
Q

Transfusion Reaction: Acute Hemolytic

A

ABO incompatibility

477
Q

Lumbar Spinal Stenosis

A

Neurogenic claudication
MC cause is degenerative osteoarthritis of spine
Relief with flexion of spine (leaning forward, walking uphill)
MRI to diagnose

478
Q

Reducing Risk of Thromboembolism in Patients with Afib

A

Warfarin or oral anticoagulants (Rivaroxaban, dabigatran, apixaban)

479
Q

Tuberculous Pulmonary Effusions

A

Very high protein levels, lymphocytosis, low glucose

480
Q

Treatment of SVC Syndrome

A

Radiation, primarily palliative treatment

Usually malignancy is a lung cancer or lymphoma

481
Q

Aspiration Pneumonia Location

A

Supine: posterior upper lobes, and superior lower lobes
Upright: right middle lobe, bases of lower lobes
- Risk of anaerobic infection: clindamycin, amoxicillin (w/ or w/o clav), or metronidazole

482
Q

Pruritic Prodrome followed by Subepidermal Blisters

A

Bullous Pemphigoid - tense bullae

Tx: high potency topical steroid (clobetasol)

483
Q

Intraepidermal Blisters

A

Pemphigus Vulgaris - fragile

- Usually oral mucosa involved as well

484
Q

Management of a Tension Pneumothorax

A

Needle decompression –> will increase venous return

485
Q

Amyotrophic Lateral Sclerosis (ALS)

A

Upper and lower motor neuron signs
Atrophied muscles and fasciculations –> LMN
Babinski and hyperactive reflexes –> UMN

486
Q

Partial Complex Seizures

A

Stare blankly then may have automatisms (chewing, lip smacking)
Post ictal confusion or Todd’s paralysis
TemporalLobe Epilepsy is a common cause

487
Q

Potential Complication of Esophageal Dilation

A

Esophageal rupture causiing mediastinitis

488
Q

ABI

A

1-1.3 normal

489
Q

Primary Hyperaldosteronism

A

Resistant HTN, Hypokalemia, Metabolic alkalosis
MC due to Bilateral adrenal hyperplasia or Aldosterone producing adrenal adenoma
Adrenalectomy for adenoma
Aldosterone antagonist (Spironolactone) for bilateral hyperplasia

490
Q

Gastric Bypass Surgery: Managing increased risk of Gallstones

A
  • Prophylactic treatment with ursodeoxycholic acid can decrease the risk
491
Q

Secondary Hyperparathyroidism

A

Hypocalcemia
Hyperphosphatemia - kidney cannot adequately excrete
Chronic Kidney Disease
- Over time results in parathyroid hyperplasia
- Renal osteodystrophy

492
Q

Neurogenic Bladder- Management

A

Suprapubic pressure, timed voids, double voiding

Cholinergic agents

493
Q

Altered Mental Status, Cirrhosis, Abdominal Pain or Fever

A

SBP

Neutrophil count >250 - ascitic fluid

494
Q

Young patient with recent viral illness, now with heart failure

A

Dilated cardiomyopathy secondary to viral myocarditis

495
Q

Painless Jaundice

A

Secondary to pancreatic cancer, until proven otherwise

496
Q

Iron Toxicity in a Child

A

Accidental poisoning
Abdominal pain, vomiting/hematemesis, explosive diarrhea
Later: hepatotoxicity and severe lactic acidosis
Tx: Defuroxamine

497
Q

Fever, night sweats + Cavitary lesion in Lung Apex and Pain in Lower Spine

A

Disseminated TB (hematogenously)

498
Q

Afib with Unintentional Weight Loss

A

Test for hyperthyroidism

499
Q

Prognosis of Astrocytomas Determined by:

A

Tumor grade: degree of anaplasia

500
Q

Chronic Lymphocytic Leukemia (CLL)

A

Severe lymphocytosis, smudge cells
Flow cytometry to diagnose: monoclonal B cell lymphocytes
Tx: Rituximab (anti- CD20 monoclonal antibody)

501
Q

Brain Abscess as Complication of IE

A

IVDA at risk
Hematogenous seeding of bacteria or systemic embolization
Focal neuro deficits, elevated ICP, vomiting, fever

502
Q

Hypovolemic Hyponatremia

A

Na

503
Q

Sickle Cell Infections

A

Pneumonia, Sepsis, Meningitis: S. pneumo

Osteomyelitis: S. Aureus, Salmonella

504
Q

Antibiotic Prophylaxis before Dental Procedures

A

Only for:
Prothetic valves, prior IE, or unrepaired congenital heard disease
Not for MVP, MR, bicuspid aortic valve, or acquired aortic valve disease

505
Q

Sensitivity

A

Identify diseased patients as diseased (+test for +disease)

506
Q

Specificity

A

Identify healthy patients as healthy (-test for -disease)

507
Q

Urinary frequency or urgency, pain, bloating, abdominal distension, and early satiety in postmenopausal woman

A

Ovarian cancer, MC is epithelial ovarian carcinoma

Pleural effusion and rectovaginal nodularity are signs of metastatic spread

508
Q

Midshaft Fracture of Humerus

A

Risk of injury to Radial Nerve and Deep brachial artery

509
Q

Management of Jaundice and Pruritus due to Advanced Pancreatic Cancer

A

Palliative endoscopic CBD stent placement to relieve obstruction

510
Q

MC causes of malignant pleural effusions

A

Breast and Lung cancer

511
Q

Rate control in Afib

A

Beta blocker or CCB

512
Q

Wide Fixed Split S2

A

Delayed closure of Pulmonic valve

- Due to ASD (L to R shunt)

513
Q

Diarrhea, abdominal pain, bloating, Eosinophilia

A

Parasitic infection most likely

514
Q

Fever + Monoarticular joint Symptoms

A

Consider Septic arthritis

  • Even in presence of a pre-existing joint disease like RA
  • Abnormal join has increased risk of infection
515
Q

Malignancy: DIC

A

Anemia in patients with DIC due to microangiopathic hemolysis
Low platelets, elevated LDH and bilirubin, elevated retic count

516
Q

Lipid Screening

A

Between ages 40-75

If Risk

517
Q

Non blanching erythema on heels

A

Early stage of a pressure ulcer

518
Q

Cisplatin: Side effect

A

Nephrotoxicity, tinnitis, hearing loss, electrolyte abnormalities, N/V, and neurotoxicity

519
Q

Juvenile Myoclonic Epilepsy

A

Progression from absence seizures (around age 10) to myclonic seizures (around age 15)
Worse with sleep deprivation

520
Q

Lennox Gastaut

A

Children under age 7, wide array of seizure types

Mental retardation

521
Q

Most important factor in reducing chest pain

A

Venous dilation

Decreases preload and as a result decreases oxygen demand

522
Q

Treating Bacterial Meningitis

A

Ceftriaxone (3rd gen cephalosporin) + Ampicillin

S. pneumo, N. meningitis, H influenza and Listeria

523
Q

Epidural Abscess

A

Diabetics, IVDA, and patients with recent hx of spinal trauma
Staph aureus is MC etiology
Tx: Vancomycin (cover for MRSA)

524
Q

Distributive Shock

A

Increased cardiac output
Decreased PVR and PCWP
- Includes sepsis and anaphylaxis

525
Q

Granulomatosis with Polyangiitis

A

Necrotizing vasculitis
Typically affects lower respiratory tract and Kidneys
Cutaneous manifestations common - local ischemia and impaired wound healing

526
Q

Myelodysplastic Syndrome

A

Macrocytic anemia (without hypersegmented neutrophils), leukopenia, and thrombocytopenia
Ovalo-macrocytes on peripheral smear
Dx: Bone marrow biopsy

527
Q

MC postinfectious complication of Impetigo

A

Glomerulonephritis

if Group A Strep infection

528
Q

Infection in Neutropenic Patient

A

Can’t mount same response
May not have a fever and may have more subtle signs of infection
Tx: empiric Abx

529
Q

DKA Biochem

A

Lack of insulin causes breakdown of fatty acids to ketones inthe liver
Increased lipolysis of peripheral fat stores secondary to high catecholamine levels

530
Q

Treatment of DKA

A

Gradual fluid resuscitation with 10ml/kg NS bolus over 1 hr
Followed by IV regular insulin drip with potassium
Transition to subcutaneous when patient is eating, gap resolved

531
Q

High Pretest Probability of PE with Low probability VQ scan

A

Get CT angiogram of chest

  • cannot rule out PE without more testing
  • PE excluded if low pretest and low VQ probabilities
532
Q

Efavirenz: Side Effect

A

NNRTI that causes neuropsych side effects: insomnia, vivid dreams, depression, and anxiety

533
Q

Management of Urge Incontinence

A

First line: bladder training

Oxybutynin (antimuscarinic) agent that relax detrusor

534
Q

Leukocytoclastic Vasculitis

A

Henoch Schonlein Purpura
Palpable, nonblanching lesions, IgA deposits
Abdominal pain and renal failure following a URI

535
Q

Joint pain that worsens throughout the day

A

Osteoarthritis

536
Q

Suspicion of Placenta Previa

A

Transabdominal U/S first, then if still suspicious, Transvaginal U/S (gold standard(

537
Q

Avoid Coadministration of Triptan and Ergotamine

A

May result in prolonged vasospasm due to overactivation of 5HT receptors –> hypertension –> MI or stroke
- Should be 24 hours between

538
Q

Strawberry tongue, Conjunctivitis (limbal sparing), polymorphous rash, and high fevers

A

Kawasaki

Scarlet fever would have tonsillar exudates or posterior pharyngeal inflammation

539
Q

Splenectomy: Effect on Platelets

A

Thrombocytosis because spleen is not there to remove old platelets from circulation

540
Q

Heart Failure: Medications that improve survival

A

ACEi, ARBs, Beta blockers (metoprolol, carvedilol, bisoprolol), Aldosterone antagonists, and Hydralazine+nitrates (in African Americans)

541
Q

First Line Tocolytic if

A

Indomethacin: COX inhibition

542
Q

First Line Tocolytic if 32-34 Weeks

A

Nifedipine: CCB

Can cause flushing, headache, hypotension, and tachycardia

543
Q

Central Cyanosis

A

Due to low arterial O2 saturation

-Blue in lips, tongue, and nail beds

544
Q

Peripheral Cyanosis

A

Increased oxygen extraction secondary to sluggish blood flow

- Blue in distal extremities

545
Q

Treating Hypertriglyceridemia

A

Fibric Acid Derivatives: Fenofibrate

546
Q

When to give Mag Sulfate for Neuroprotection

A

Less than 32 weeks

547
Q

When to give Tocolytics

A

Less than 34 weeks

548
Q

Antenatal corticosteroids (betamethasone)

A

If

549
Q

MC Location of Ulnar Nerve Compression

A

Elbow

  • paresthesias in 4th and 5th digits, and medial forearm
  • weakness of intrinsic hand muscles
550
Q

Roseola Infantum

A

MC caused by HHV-6
Blanching maculopapular rash after 3-5 days of very high fever
Age

551
Q

Treatment of Raynaud’s

A

CCB like Nifedipine

552
Q

Sudden Onset Syncope without Prodrome

A

Most consistent with arrhythmia

(ventricular arrhythmia)

553
Q

Initial treatment for Torsades in patients who are Hemodynamically Stable

A

Mag Sulfate (even if mag level is normal)

554
Q

Prolonged QT

A

Due to certain medications, hypokalemia, or hypomagnesemia

Risk of developing Torsades

555
Q

Supracondylar Humerus Fracture: Complication

A

Small risk of Compartment syndrome

MC complication: Risk of injury to brachial artery, frequently check radial pulse

556
Q

Chondrocalcinosis

A

Meniscal Calcification

Seen with Pseudogout (calcium pyrophophate crystals -rhomboid)

557
Q

Levodopa/Carbidopa: Side effects

A

Somnolence, confusion, Hallucinations

Dyskinesia/Involuntary movements (after 5-10 years of therapy)

558
Q

Cryptorchidism

A

Orchiopexy in infancy prevents testicular torsion, improves fertility, and decreases risk of testicular malignancy

559
Q

Thyroid Hormones in Pregnancy

A

Increased Total T4 and T3
Increased TBG
Net results of: Decreased TSH, slightly elevated Free T4 and T3

560
Q

Felty Syndrome

A

RA + Neutropenia + Splenomegaly
Vasculitis (necrotizing skin lesions)
may also have anemia, thrombocytopenia, and lymphadenopathy
High RF titers, occurs late in disease

561
Q

Treatment for Simple and Complex Partial Seizures

A

Phenytoin and Carbemazepine

- Ethosuximide and Valproic acid for Absence seizures

562
Q

Radiographic changes seen with RA

A

Bony erosions and periarticular decalcifications

Narrowing of joint space (thinned cartilage)

563
Q

Adult onset Still’s Disease

A

High spiking fevers, joint pain, salmon colored bumpy rash

Enlarged spleen and liver, lymphadenopathy

564
Q

Methotrexate: Must supplement ____

A

Folate

565
Q

Radiographic Findings in OA

A

Subchondral sclerosis
Subchondral cysts
Joint narrowing

566
Q

Probenecid

A

Prevents acute gout attacks
Uricosuric agent: increases excretion of uric acid
Only use if decreased excretion

567
Q

Allopurinol

A

Prevents acute gout attacks, never use in acute attack
Xanthine oxidase inhibitor
Decreases production of uric acid
- Risk of SJS

568
Q

Treatment for Acute Gouty Attack

A

NSAIDs (first line); Bed rest (early ambulation may cause attack)
Colchicine (2nd)
Steroids (3rd)

569
Q

Leading Cause of Death with Acromegaly

A

Cardiac cause (increased incidence of coronary heart disease, cardiomyopathy, LVH, diastolic dysfunction, and arrhythmias)

570
Q

Indications for ECT for Depression

A

Treatment resistance
Psychotic features present
Pregnant, refusal to eat or drink, imminent risk of suicide

571
Q

Most Common Complication of Sickle Cell Trait

A

Painless microscopic or gross hematuria

572
Q

Heart Defect in Edwards (Trisomy 18)

A

VSD - Holosystolic murmur at LLSB

573
Q

Immune Thrombocytopenia: Peripheral Smear Findings

A

Few large platelets (megakaryocytes)

574
Q

Retropharyngeal Abscess

A

Neck pain, odynophagia, fever following trauma to posterior pharynx
Infection can drain into superior mediastinum
Extension through alar fascia (danger space) can transmit infection into posterior mediastinum –> acute necrotizing mediastinitis

575
Q

Conn’s Syndrome

A

Primary Hyperaldosteronism - adenoma or b/l hyperplasia
HTN, Hypokalemia
Metabolic alkalosis
Low renin, High Aldosterone, High bicarb

576
Q

Osteomalacia (Vit D deficiency MC cause)

A 
Vit D deficiency: decreased intestinal Ca and P absorption
Decreased bone density, pseudofractures
Hypocalcemia and Hypophosphatemia
Elevated PTH (worsens low phos)
577
Q

Enthesitis

A

Inflammation and pain at sites where tendons and ligaments attach to bone
- Aw/ Ankylosing spondylitis

578
Q

Nail Puncture Wound through Shoe

A

Osteomyelitis dye to Pseudomonas Aeruginosa

579
Q

Smooth round big cyst filled with small cysts in Liver

A

Echinococcus (dog or sheep)

Hydatid cyst

580
Q

Increased TRH

A

Stimulates Prolactin production

- May lead to hypothyroidism

581
Q

Clubfoot

A

Equinus and varus of the calcaneum and talus, varus mdfoot, adduction of forefoot
Tx: Stretching and manipulation of foot followed by serial plantar casts
- Surgery if needed, between 3-6 months of age

582
Q

Spondylolisthesis

A

Forward slip of vertebrae in Preadolescent Children

  • Palpable Step Off at the lumbosacral area
  • Back pain, neurologic dysfunction (urinary incontinence)
583
Q

Carotid Artery Dissection

A

Potential complication of seemingly minor penetrating trauma to oropharynx or neck strain/manipulation
Hemiparesis, facial droop, and aphasia

584
Q

Mediastinal Mass: 4 T’s

A

Thymoma, Teratoma, Thyroid, and Terrible Lymphoma

585
Q

Tabes Dorsalis

A

Neurosyphilis
Sensory ataxia, Posterior/dorsal columns, reduced/absent DTRs
Lancinating pains
Argyll Robertson Pupils

586
Q

Hyperkalemia: EKG Changes

A

Tall peaked T waves
PR prolongation
QRS Widening

587
Q

Spared Eye Injury (Sympathetic Ophthalmia)

A

Damage of one eye after a penetrating injury to the other eye
Immune mechanism involving recognition of “hidden” antigents

588
Q

Acquired Torticollis

A

Common condition in children
Caused by: URI, minor trauma, cervical lymphadenitis, and retropharyngeal abscess
Need cervical spine xrays to r/o fracture or dislocation

589
Q

Strong clinical suspicion of Syphilis but Negative Serology

A

Empirically treat with penicillin

- biopsy is not useful, cannot culture t. pallidum

590
Q

Osteoid Osteoma

A

Benign bone forming tumor
- Adolescent and early adult males
Proximal femur, pain worse at night, relieved by NSAIDS
Small, round lucency with sclerotic mmargins

591
Q

Hazard Ratio

A

More than 1 = event more likely in Treatment Group

Less than 1 = event less likely in Treatment Group

592
Q

Rapidly Developing Hyperandrogenism

A 
Androgen secreting neoplasm
In ovary (elevated Testosterone) or adrenal glands (elevated DHEAS)
593
Q

Febrile Neutropenia

A

Usually do to chemotherapy
Initial management: Empiric monotherapy with an Anti-Pseudomonal agent
(pip-tazo, meropenem, or cefepime)

594
Q

Cerebral Amyloid Angiopathy

A

MC cause of spontaneous lobar hemorrhage in elderly
Due to B-amyloid deposition in cerebral arteries
Aw/ Alzheimers

595
Q

Symptoms of Polycythemia in Neonates

A

Respiratory distress, hypoglycemia, and neurologic manifestations

596
Q

Renal stones: Imaging

A

Ultrasound or Non-contrast spiral CT of abdomen and pelvis

- U/S in pregnancy

597
Q

Cervical Discharge During Ovulation

A

Clear, profuse and thin cervical musuc

Stretch to 6 cm, ferning on microscopy

598
Q

Lichen Planus

A

Purple planar, polygonal, pruritic, plaques

Flexure surfaces of extremities

599
Q

Succinylcholine Contraindication

A

Hyperkalemia or risk of hyperkalemia (burn or crush injuries, demyelinating syndromes, tumor lysis syndrome)

600
Q

MC cause of Nonpurulent Cellulitis

A

Group A strep

601
Q

Hypotension, JVD, and new onset RBBB

A

Massive PE

602
Q

Euthyroid Sick Syndrome

A

Patient with acute, severe illness
Low T3 syndrome
T4 and TSH are normal

603
Q

Defective Mineralization of Organic Bone Matrix

A

Osteomalacia

- Severe vit D deficiency

604
Q

Herpetic Whitlow

A

Common viral infection of the hand (HSV 1 or 2)
Self limiting
Health care workers in direct contact with infected orotracheal secretions are at increased risk

605
Q

Atlantoaxial Instability

A

Suspect in patient with Down’s Syndrome with UMN findings
Due to excessive laxity of posterior transverse ligament
Leg spasticity, hyperreflexia, +babinski, clonus

606
Q

Bacillary Angiomatosis

A

Bartonella henslae affects immunosuppressed (HIV)
Constitutional symptoms + Cutaneous and Visceral angioma like blood vessel growths
large pedunculated exophytic papule with collarette of scale
Antibiotics cause lesion regression

607
Q

Risk factors for Carpal Tunnel

A

Obesity, Diabetes, Pregnancy, and Hypothyroidism

608
Q

Clinical Features of Secondary Amyloidosis

A

Inflammatory arthritis, chronic infections (bronchiectasis), IBD, malignancy, vasculitis

  • Proteinuria
  • Cardiomyopathy
  • Hepatomegaly
609
Q

Foodborne Botulism

A

Improperly canned food or cured fish
Bilateral cranial neuropathies
Symmetric descending muscle weakness
Tx: equine anti-toxin

610
Q

23PPSV Immune Response

A

T cell Independent - B cell response

611
Q

13PCV Immune Response

A

Robust T cell dependent B cell response

612
Q

Transient Synovitis

A

Followed a viral infection usually
Pain, decreased ROM, limping but CAN bear weight
Rarely fever or lab abnormalities (unlike septic arthritis which has fever, high WBC, and high ESR, unable to bear weight)
- Do not need arthrocentesis unless concerned for septic

613
Q

Erythema Chronicum Migrans

A

Pathognomonic for early localized Lyme

Tx: Amoxicillin if

614
Q

Aromatase Deficiency

A

Total absence of poor functioning enzyme to convert androgens to estrogens
Masculinization in mother (resolves postpartum)
Virilized XX child
Later in life: very low estrogen, high FSH and LH

615
Q

Managing Opioid Withdrawal

A

Oral or IM methadone

616
Q

Management of TTP

A

Plasma exchange to removed autoantibodies (ADAMST13) Microangiopathic hemolytic anemia and thrombocytopenia are life threatening

617
Q

Osler Weber Rendu

A

AD disorder, hereditary telengectasia

Diffuse telengectasias, recurrent epistaxis, widespread AVMs

618
Q

Management of Afib due to Hyperthyroidism

A

Beta blockers (propranolol)

619
Q

TPN: Gallstones

A

Due to gallbladder stasis

Since no CCK stimulating contraction

620
Q

High Steppage Gait

A

Due to foot drop

L5 radiculopathy or Neuropathy of common peroneal nerve

621
Q

Negative Predictive Value

A

Probability of being Disease-free if Test result is negative

NPV varies with pretest probability (and prevalence)

622
Q

Mimics Sarcoidosis

A

Histoplasmosis

Non-caseating granulomas in lungs

623
Q

Wiskott Aldrich Syndrome

A

Thrombocytopenia, Eczema, and Immune Dysfunction

WASp gene - impaired cytoskeleton

624
Q

Hyperventilation To Reduce ICP

A

Cerebral vasoconstriction due to decreased paCO2

625
Q

Prolactinoma Hormone Levels

A

Prolactin usual >200
LH low
TSH normal

626
Q

Wernickes’ Encephalopathy

A

Encephalopathy, ocular dysfunction, gait ataxia

Tx: thiamine then glucose

627
Q

AAA Screening

A

Age 65-75, former or current smokers

628
Q

CMV Diarrhea in HIV Patients

A

Frequent small volume diarrhea
Hematochezia
Abdominal pain, weight loss, low grade fever

629
Q

MAC Diarrhea in HIV Patients

A

Watery Diarrhea
High fever >102
Weight loss

630
Q

Medication Induced Psychosis

A

Delusions or hallucinations associated with medication

High dose glucocorticoids are often implicated

631
Q

Niemann Pick vs Tay Sachs

A

Both have cherry red spot, regression of milestones, hypotonia
Niemann Pick: Sphingomyelinase - hepatosplenomegaly
Tay Sachs: B hexosaminidase - hyperreflexia

632
Q

Krabbe Disrease

A

Galactocerebrocidase - lysosomal storage disorder

Developmental regression, hypotonia, areflexia

633
Q

Gaucher Disease

A

Glucocerebrosidase

Anemia, thrombocytopenia, hepatosplenomegaly

634
Q

Chaga’s Disease

A

Protozoal Disease by T cruzi
Megacolon/esophagus
Cardiac disease - Myocarditis –> dilated cardiomyopathy

635
Q

Contraindications to Breastfeeding

A

Galactosemia in infant
Active TB, HIV infection, Herpetic breast lesions, Very recent varicella infection, Certain medications, Chemo/radiation, Active drug or EtOH use

636
Q

Breastfeeding: Reduced Cancer Risk

A

Breast and Ovarian

637
Q

Electrolytes in Cushings Syndrome

A

Hypokalemia

Hypernatremia, Hyperglycemia

638
Q

Renal Effects of CHF

A

RAAS Activation due to Decreased Renal Perfusion

- Vasoconstriction of Efferent arterioles to maintain GFR

639
Q

Pregnant Women with Hx of Anorexia

A

Risk of IUGR, miscarriage, hyperemesis gravidarum, premature birth, postpartum depression

640
Q

Biliary Atresia

A

Initially well, over 1-8 weeks develop:
Jaundice, Pale stool, Dark urine, Hepatomegaly
Conjugated Hyperbilirubinemia
Tx: Kasai procedure or Liver transplant

641
Q

Empyema or Parapneumonic Effusion: Pleural Fluid

A

Low glucose (

642
Q

Wallenberg Syndrome

A

Lateral medulla
Vertigo, nystagmus, hoarseness, Horners
Loss of pain and temp in ipsi face and contra body

643
Q

Wilm’s Tumor

A

Does not cross midline (unlike neuroblastoma)
MC renal neoplasm of childhood
Asymptomatic abdominal mass, age 2-5
Hematuria

644
Q

Pertussis: Household Contacts

A

Prophylaxis with a macrolide is recommended for all close contacts Despite vaccination status
If not vaccinated, should also receive vaccine with macrolide

645
Q

Premature adrenarche

A

Early activation of adrenal androgen release
Obese, black or hispanic
Pubic hair, axillary hair, acne, body odor
NO breast development

646
Q

Tactile Fremitis

A

Consolidation: Increased (increased breath sounds)

Effusion/Pneumothorax/Atelectasis: Decreased

647
Q

Homocysteine: Hypercoagulable

A

Vit B6, B12 and folate involved in metabolism

can help lower levels

648
Q

Inpatient Tx for CAP

A

Fluoroquinolone (Levofloxacin or Moxifloxacin)
OR
Beta-Lactam plus Macrolide

649
Q

Anemia of Prematurity

A

Impaired EPO production
Usually asymptomatic
Low hemoglobin and Low retic count
Normocytic and normochromic

650
Q

Management of Acute Cocaine Toxicity

A

Supplemental O2 and IV benzo

651
Q

Tx for Pinworm (Enterobius)

A

Albendazole or Pyrantel Pamoate

652
Q

Cutaneous Larva Migrans

A

Serpiginous raised Lesions, pruritic
Skin contact with feces contaminated soil/sand
- Hookworm (cat or dog)

653
Q

Blunt Trauma: Pancreatic Contusion or Laceration

A

May not be visible on initial CT
Later will present with fever, chills, deep abdominal pain
suggests retroperitoneal abscess

654
Q

Nonfunctioning Pituitary Adenoma

A

Hypopituitarism with mildly elevated prolactin (unlike a functional adenoma, >200 suggests prolactinoma)
Hypogonadism, hypothyroidism

655
Q

Hypocalcemia in Alcoholics

A

Consider Hypomagnesemia

- Low Mg decreases PTH release

656
Q

Werdnig Hoffman Syndrome

A

AR, degeneration of anterior horn cells
SMA (spinal muscular atrophy) - proximal and more lower extremity, does not affect pupiles
Floppy baby syndrome

657
Q

Congenital Hypothyroidism

A

Normal at birth
MC cause: thyroid dysgenesis
Develop apathy, weakness, hypotonia, large tongue, abdominal bloating, umbilical hernia, sluggish movement

658
Q

Diabetic Retinopathy Findings

A

Microaneurysms, hemorrhages, exudates, retinal edema, cotton wool spots, neovascularization

659
Q

Calcium During Respiratory Alkalosis

A

Increased binding of Ca to Albumin

Decreased in ionized calcium (unbound)

660
Q

Antibiotics for UTI in Pregnancy

A

Nitrofurantoin (5-7 days)
Amox or Amox+Clav (3-7 days)
Fosfomycin (1 dose)

661
Q

Acute Cervical Lymphadenitis

A

Bilateral: adeno or EBV
Unilateral: Staph aureus or S. pyogenes (red tender), Anaerobic bacteria (if poor dental hygiene), Bartonella (cat), Mycobacterium avium (gradual, non-tender)

662
Q

Posterior Fossa Tumors

A

In children
Cerebellar Astrocytoma (MC)
Medulloblastoma (2nd MC)
- Truncal or gait instability, increased ICP

663
Q

Study to confirm Carpal Tunnel

A

Nerve conduction study -shows slowing of median nerve

664
Q

Tx of Tinea Corporis (Ringworm)

A

Topical antifungal (clotrimazole or terbinafine)

665
Q

Age at which Bedwetting is Normal

A

5 yrs or under

666
Q

Eczema Herpeticum

A

Eczema with superimposed HSV1
Painful vesicles that become punched out erosions with hemorrhagic crusting
Tx: systemic acyclovir

667
Q

Confidence Interval

A

If 95% CI
p .05 if null value is inside interval
(RR = 1 means no association –> null value)

668
Q

Erythema Toxicum Neonatorum

A

Benign evanescent rash
Changes appearance and occurs on any part of the body
During the first 2 weeks of life

669
Q

Suspected Mono, negative heterophile antibody

A

Sometimes test is negative early in disease, may be helpful to recheck

670
Q

MC cause of Bacterial Meningitis in Children and Young Adults

A

Neisseria Meningiditis

671
Q

Rapidly Correct Hyponatremia

A

CPM (Osmotic demyelination)

672
Q

Rapidly Correct Hypernatremia

A

Cerebral Edema

673
Q

Causes of Clubbing

A

Lung Malignancy, cystic fibrosis, and R to L cardiac shunts

COPD does not cause clubbing

674
Q

Benzodiazepine Overdose

A

Slurred speech, unsteady gait, drowsiness

Normal pupil size (unlike opioids)

675
Q

Langerhans Histiocytosis

A

Solitary painful lytic bone lesion with overlying swelling

Hypercalcemia

676
Q

Acute unilateral Motor deficit (no sensory deficit)

A 
Lacunar stroke (internal capsule)
Aw/ chronic HTN
677
Q

Aminoglycoside Side effect

A

Ototoxicity

Vestibulopathy with some (gentamycin)

678
Q

Pellagra

A

Niacin Deficiency - diets primarily consisting of corn
Diarrhea (nausea, abdominal pain)
Dermatitis (sunburn-like, thick, hyperpigment)
Dementia (irritable, aggressive)
Prolonged isoniazid therapy can eventually cause it

679
Q

TB RIPE Drugs: Hepatooxic

A

Only replace if patient is symptomatic, has history of liver disease, or drinks alcohol
Mild LFT elevations are normal, and self limited

680
Q

Ehrlichiosis

A

Tick, southeast and south central US
Confusion, flu-like illness, No rash
Thrombocytopenia and Leukopenia, Elevated LFTs
Tx: Doxycycline

681
Q

Stridor

A

Croup/laryngotreacheobronchitis - barky cough, runny nose
Laryngomalacia: worse in supine
Foreign body: acute onset
Vascular ring: persistent stridor, improves with neck extension, aw/ cardiac abnormalities

682
Q

Tx of Panic Attacks

A

Immediate distress: benzo

Long term: SSRI/SNRI and/or CBT

683
Q

Hypertension and Hypokalemia

A

Check plasma aldosterone/renin ratio

684
Q

Primary Amenorrhea

A

No secondary development (hair or breast)
FSH measurement:
if low, pituitary MRI, If high, karyotype

685
Q

Hypopituitarism

A

Low glucocorticoid
Hypogonadism
Hypothyroidism
Normal aldosterone (because ACTH independent)

686
Q

Babesiosis

A

Tick, ixodes, northeast US
Hemolysis, jaundice
Illness more significant in patients >40, asplenic or immunocompromised patients

687
Q

Bacterial Meningitis Management

A

Age 2-50: Vanc + 3rd gen cephalosporin
Age >50: Vanc + 3rd gen ceph + amp
If immunocompromised: Vanc + amp + cefepime (for Gm-rods)

688
Q

Older children with Intussusception

A

Suspect a pathological lead point

MC is Meckels Diverticulum

689
Q

MC Infection aw/ FSGS

A

HIV

690
Q

MC infection aw/ Membranous Nephropathy

A

Active Hep B

691
Q

Unilateral varicocele that fails to empty

A

Suspicious for a mass obstruction like RCC

692
Q

Tx for Hairy Cell leukemia

A

Cladribine

693
Q

Bite Cells and Heinz Bodies

A

G6PD

694
Q

Hemi-neglect Syndrome

A

Ignoring Left side of space

Nondominant (Right) parietal lobe is affected

695
Q

Cyclical VOmiting

A

Recurrent self-limited episodes of vomiting or nausea
Normal workup, no symptoms between
Family hx of migraines

696
Q

Ramsay Hunt Syndrome

A

Herpes zoster infection in the ear
Facial nerve palsy
Vesicles in the auditory canal and auricle

697
Q

Rectovaginal Fistula

A

After obstetric trauma
Malodorous brown/tan discharge
Red velvety rectal mucosa seen on posterior vaginal wall

698
Q

Electrolytes in Primary Adrenal Insufficiency (Cortisol/Mineralocorticoid deficiency)

A

Hyponatremia

Hyperkalemia

699
Q

PML (progressive multifocal leukoencephalopathy)

A

HIV patient with focal neurological signs
Multiple brain lesions on CT (no mass effect)
Non-enhancing

700
Q

Management of Mucormycosis

A

Aggressive surgical debridement + early IV amphotericin B

701
Q

CMV Retinitis

A

Blurred vision, floaters, sensation of flashing lights
Seen in HIV patients - can cause blindness
Yellow-white fluffy hemorrhagic lesions along vasculature
Tx: valgancyclovir

702
Q

Leprosy

A

Insensate, hypopigmented patch of skin

Dx: skin biopsy –> acid fast bacilli

703
Q

Ice Pack Test: Improvementof Ptosis

A

Supports diagnosis of Myasthenia Gravis

Cold temp inhibits Ach breakdown

704
Q

Pulseless Electrical Activity (PEA)

A

Rhythm without pulses

Manage with Chest Compressions and vasopressors to maintain perfusion

705
Q

Pineaoloma

A

Parinaud Syndrome
Limited upward gaze, headache, vomiting, hydrocephalus
Upper eyelid retraction
Pupils non-reactive to light, but will accomodate

706
Q

Whipple Disease

A

T. Whippelii
Chronic malabsorptive diarrhea, weight loss
Non-deforming Arthritis
Lymphadenopathy and Low grade Fever

707
Q

Norepinephrine Induced Vaspospasm

A

Pressors like NE can cause distal fingers and toes become dusky blue and cool due to vasconstriction in periphery

708
Q

Interstitial Pneumonitis Due to Amiodarone

A

Progressive dyspnea, nonproductive cough

Reticular or ground glass opacities on CXR

709
Q

Hemolytic Uremic Syndrome (HUS)

A

Bloody Diarrhea (e coli o157h7 or shigella)
Petechiae or bruising
Hemolytic Anemia, Thrombocytopenia
Increased Creatinine

710
Q

Henoch Schonlein Purpura (HSP)

A

Purpura on buttocks and legs
Abdominal and Joint pain
Acute renal failure
NORMAL platelets

711
Q

Cholesterol Emboli

A

Renal failure, skin manifestations, and GI symptoms after a recent vascular procedure
Livedo Reticularis or Blue toe syndrome
Eosinophilia, Low complement

712
Q

TB Test: PPD

A

Treat if:
>5 with HIV, recent TB contact, CXR, or transplant pt
>10 if recent immigrant, IVDA, high risk setting (prison, homeless, hospital), children
>15 for healthy

713
Q

Ecstacy (MDMA)

A

Amphetamine that increases NE, dopamine, and serotonin
HTN, tachycardia, hyperthermia
Serotonin Syndrome
Hyponatremia

714
Q

Untreated Hyperthyroidism

A

Rapid bone loss due to increased osteoclastic activity
Tachyarrhythmias (including Afib)
Fetal Hyperthyroidism (if Graves, not toxic adenoma)

715
Q

Bleeding >8 weeks Postpartum

A

Concern for Choriocarcinoma (GTD)
Irregular bleeding, large uterus, pelvic pain
Pulmonary symptoms (multiple pulmonary nodules/mets)
Elevated beta hCG to diagnose

716
Q

Pseudocyesis

A

Women with signs and symptoms of pregnancy
Normal endometrial stripe
Reported positive pregnancy test but negative in office
Form of conversion disorder

717
Q

Vitamine Deficiency in Carcinoid Syndrome

A

Niacin

718
Q

Initial Management of Massive Hemoptysis

A

Secure airway then bronchoscopy to identify and stop bleeding source
Bleeding lung dependent position (lateral)

719
Q

Brain abscess from Sinusitis

A

MC pathogens are Viridans streptococci and head and neck anearobes

720
Q

Chikungunya Fever

A

Central and South america, mosquito
High fever, Polyarthralgias
Maculopapular rash on limbs and trunk
Thrombocytopenia, lymphopenia, LFTs

721
Q

RA: Effect on Spine

A

Cervical spine MC affected

Can cause spinal cord compression due to subluxation

722
Q

Waldenstrom Macroglobulinemia

A

Hyperviscosity
Hepatosplenomegaly
Neuropathy
IgM monoclonal spike (M spike)

723
Q

Thalamic Pain Syndrome

A

Weeks to months after a stroke
Patient may have severe paroxysmal burning over affected area
Exacerbated with light touch

724
Q

Alcohol Hallucinosis

A

Withdrawal symptom within 12-24 hours
Resolved in 24-48 hours
Vital signs stable
Alert with visual hallucinations

725
Q

Hypertensive Emergency in Pregnancy

A

Labetalol
If risk of bradycardia, Hydralazine
Methyldopa is for chronic BP control

726
Q

Trastuzumab: Side Effect

A

Risk of developing cardiotoxicity especially in patients with low ejection fractions
- Get baseline Echo prior to starting

727
Q

Rapid Reversal of Warfarin

A

Prothrombin Complex Concentrate
If not FFP
IV Vit K takes too long

728
Q

Treatment of Disseminated Histoplasmosis

A 
IV Amphotericin B (1-2 weeks) 
Followed by maintenance therapy:
Oral Itraconazole (1 year)
729
Q

Cancer Related Cachexia

A

Progesterone analogs increased appetite and weight gain

- Megestrol acetate or medroxyprogesterone acetate

730
Q

HIT: Classic Skin Sign

A

Skin necrosis at site of abdominal injection of subcutaneous heparin

731
Q

Afib: MC location of Ectopic Foci

A

Pulmonary veins

732
Q

Legg Calve Perthes

A

Idiopathic osteonecrosis (avascular necrosis) of femoral head
Boys age 4-10
Insidious hip pain, antalgic gait, pain for >1 month

733
Q

Dubin Johnson

A 
Black LIver
Conjugated hyperbilirubinemia (not hemolysis)
734
Q

Rotor Syndrome

A

Defect in hepatic storage of conjugated bilirubin
Conjugate hyperbilirubinemia
Liver is not Black

735
Q

Drug to Facilitate Renal Stone Passage

A

Alpha 1 blockers

- Tamsulosin

736
Q

Hyposthenuria

A

Impairment in kidney’s ability to concentrate urine

  • Nocturia
  • Aw/ sickle cell, less severe in sickle cell trait
737
Q

Holosystolic Murmur that Increases in Intensity with Inspiration

A

Tricuspid Regurgitation

738
Q

ASCUS

A

If age 21-24 repeat pap in 1 year

If 25+: HPV (if positive, colp; if negative repeat pap and hpv in 3 years)

739
Q

Primidone: Side effect

A

May precipitates acute intermittent porphyria

  • abdominal pain
  • neuro psych abnormalities
740
Q

Pancreatic Cancer: Effect on Gallbladder

A 
Distended gallbladder (courvoisier sign)
Dilated intra and extrahepatic ducts
741
Q

Management of Peritonsillar Abscess

A

Needle aspiration followed by IV antibiotics

742
Q

Harsh Holosystolic Murmur at LLSB

A

VSD

Get an Echo to evaluate size and location, rule out other defects

743
Q

Myotonic Dystrophy

A

AD, CTG trinucleotide repeat expansion
Facial weakness, hand grip (delayed muscle relaxation), dysphagia, cardiac arrhythmias
Cataracts, Balding, Testicular atrophy

744
Q

Penile Fracture

A

Emergent urethrogram to assess for urethral injury and emergent surgery to evacuate hematoma

745
Q

Drugs for Stable Angina

A

Beta blockers (1st line)
- Controls sx and improves exercise tolerance
CCBs
Nitrates

746
Q

Fanconi Anemia

A 
Aplastic anemia and progressive bone marrow failure
Chromosomal breaks
- Short stature, microcephaly
- Abnormal thumbs
- Hypo/hyperpigmented areas
- Low set ears, middle ear abnormalities
747
Q

Heat Exhaustion vs Heat Stroke

A

Exhaustion: Inadequate fluids and sodium, Temp 104, AMS

748
Q

Management of CRAO

A

Emergent: Ocular massage and high flow O2

749
Q

Factor V Leiden

A

MC in caucasian
Activated Protein C resistance
Hypercoagulability - PE or DVT in young patient

750
Q

Familial Hypocalciuric Hypercalcemia

A

CaSR mutation - cannot sense calcium
High/normal PTH, High Ca
Low Urine calcium/creatinine ratio

751
Q

Acute liver failure

A

Elevated enzymes
Hepatic encephalopathy
Impaired synthetic function (High INR)

752
Q

Hyperthyroidism: Myopathy

A

Proximal muscle weakness, possible muscle atrophy, high frequency low amp tremor, normal or increased DTR
- Hip flexors and quads predominantly affected

753
Q

Fatty Casts

A

Nephrotic Syndrome

754
Q

Broad Waxy Casts

A

Chronic Renal Failure

755
Q

WBC Casts

A

Pyelonephritis
OR
Interstitial Nephritis

756
Q

Shock Due to Massive PE

A

Elevated Pulm Artery Pressure and RA pressure
–> pulmonary HTN
Normal PCWP, Hypotension, Decreased Cardiac output

757
Q

Linear Ulcers in Esophagus

A

CMV esophagitis

758
Q

Punched Out Ulcers in Esophagus

A

HSV Esophagitis

759
Q

Candida Esophagitis

A

Pain with swallowing and white plaques in mouth

760
Q

Treatment of Catatonia

A

Benzodiazepine (Lorazepam challenge) and/or ECT

761
Q

Thyroid Lymphoma

A

Risk is 60x more in patients with Hashimoto’s Thyroiditis

762
Q

Metatarsus Adductur

A

Medial deviation of forefoot

Tx: none, reassurance, usually corrects self

763
Q

Drugs that may cause Folate Deficiency

A

Phenytoin, methotrexate, and trimethoprim

764
Q

De Quervain Tenosynovitis

A 
Classically affects new mothers
Thumb pain (pain on palpation to radial side)
765
Q

PBC: Hyperlipidemia

A

Hyperlipidemia with xanthelasmas can be a common complication of Primary Biliary Sclerosis

766
Q

Nephrotic Syndrome: Hyperlipidemia

A

Accelerates atherosclerosis

Especially with hypercoagulability

767
Q

Pulmonary Nodules surrounded by Ground glass Opacities

A

Halo Sign

Invasive Aspergillosus

768
Q

Meningitis with Purpura

A

Gononcoccal Meningitides

Meningococcal meningitis

769
Q

14-3-3 CSF assay or Periodic sharp wave complexes on EEG

A

Creutzfeldt Jakob disease

Rapidly progressing dementia and myoclonus

770
Q

Coccidiomycosis

A

Arizona/California, south west US
Fever, fatigue, dry cough, weight loss
Pleuritic chest pain
Erythema nodosum and multiforme

771
Q

MC Source of PE

A 
Proximal Thigh (Ilial, femoral, or popliteal) deep veins
>90% of acute PEs
772
Q

Meds to Hold Prior to Cardiac Stress Test

A

B-blockers, CCBs, and nitrates

hold 48 hours

773
Q

Low volume Hemoptysis after URI, no weight loss

A

Assumed Bronchitis

774
Q

Herpangina

A

Coxsackie A
Summer/early fall
Gray vesicles/ulcers on Posterior Pharynx
Tonsillar pillars

775
Q

HSV1

A

Erythematous gingiva

Clusters of small vesicles on Anterior oropharynx and Lips

776
Q

Hypercalcemia due to Immobilization

A

Due to increased osteoclastic activity

Use bisphosphonates to reduce Ca and prevent bone loss

777
Q

Management of Narrow Complex SVT

A

Synchronized cardioversion if Unstable

778
Q

Otosclerosis

A

Conductive hearing loss (abnormal rinne)

Adults, usually female, age 20s-30s

779
Q

Evaluation of Febrile UTI in child

A

Renal and bladder ultrasound

780
Q

UC Bimodal Occurrence

A

Age 20s-30s and also in 60s

Step 2 CK (1 decks)

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